Exploring Medical and Public Health
Preparedness for a Nuclear Incident
PROCEEDINGS OF A WORKSHOP
Leslie Pray, Benjamin Kahn, and Scott Wollek, Rapporteurs
Forum on Medical and Public Health Preparedness for
Disasters and Emergencies
Board on Health Sciences Policy
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was jointly supported by contracts between the National Academy of Sciences and the American Burn Association; American College of Emergency Physicians; American College of Surgeons’ Committee on Trauma; American Hospital Association; American Red Cross; Association of Public Health Laboratories; Association of State and Territorial Health Officials; Council of State and Territorial Epidemiologists; East West Protection; Emergency Nurses Association; GlaxoSmithKline; Healthcare Ready; Infectious Diseases Society of America; National Association of Chain Drug Stores; National Association of County & City Health Officials; National Association of Emergency Medical Technicians; Robert Wood Johnson Foundation; Sequirus; Trauma Center Association of America; U.S. Department of Defense (Contract No. HHSP233201400020B/HHSP23337014); U.S. Department of Defense, Uniformed Services University of the Health Sciences (Contract No. HU0001-16-1-0022); U.S. Department of Health and Human Services, Administration for Children and Families (Contract No. HHSP23320140020B/HHSP23337065); U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (Contract No. 200-2011-38807, TO #54); U.S. Department of Health and Human Services, Food and Drug Administration (Contract No. 1R13FD005495-01); U.S. Department of Health and Human Services, National Institutes of Health (Contract No. HHSN26300084); U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (Contract No. HHSO100201550005A); and U.S. Department of Transportation, National Highway Traffic Safety Administration (Contract No. DTNH22-14-H-00468). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-48914-0
International Standard Book Number-10: 0-309-48914-8
Digital Object Identifier: https://doi.org/10.17226/25372
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Copyright 2019 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Exploring medical and public health preparedness for a nuclear incident: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25372.
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PLANNING COMMITTEE ON EXPLORING MEDICAL AND PUBLIC HEALTH PREPAREDNESS FOR A NUCLEAR INCIDENT1
JAMES BLUMENSTOCK (Co-Chair), Chief, Health Security, Association of State and Territorial Health Officials
TENER VEENEMA (Co-Chair), Professor of Nursing and Public Health, Johns Hopkins University School of Nursing and Johns Hopkins Bloomberg School of Public Health
STEVEN M. BECKER, Professor, Community and Environmental Health, Old Dominion University
JOHN BENITEZ, Medical Director, Emergency Preparedness, Tennessee Department of Health
STEPHEN BROOMELL, Assistant Professor, Social and Decision Sciences, Carnegie Mellon University
CHAM DALLAS, University Professor of Health Policy and Management, Director, Institute for Disaster Management, University of Georgia
DAVID EISENMAN, Associate Professor, David Geffen School of Medicine and Fielding School of Public Health, University of California, Los Angeles
BRUCE EVANS, Fire Chief, Upper Pine River Fire Protection District
CHAD HRDINA, Director, Division of Requirements, U.S. Department of Health and Human Services
ANN KNEBEL, Deputy Scientific Director, Division of Pre-Clinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health
JOHN KOERNER, Senior Special Adviser, Chemical, Biological, Radiological, Nuclear, High-Yield Explosive (CBRNE) Science and Operations, Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services
ROBERTA LAVIN, Executive Associate Dean of Academic Affairs and Professor, University of Tennessee College of Nursing
MARTHA LINET, Senior Investigator, Radiation Epidemiology Branch, National Cancer Institute, National Institutes of Health
MATTHEW K. WYNIA, Director, Center for Bioethics and Humanities, University of Colorado Denver
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
Health and Medicine Division Staff
SCOTT WOLLEK, Senior Program Officer
BEN KAHN, Associate Program Officer
REBECCA RAY, Senior Program Assistant (until December 2018)
ANDREW M. POPE, Director, Board on Health Sciences Policy
Consultant
LESLIE PRAY, Science Writer
FORUM ON MEDICAL AND PUBLIC HEALTH PREPAREDNESS FOR DISASTERS AND EMERGENCIES1
DAN HANFLING (Co-Chair), Contributing Scholar, Center for Health Security, Johns Hopkins Bloomberg School of Public Health
SUZET M. McKINNEY (Co-Chair), Executive Director and Chief Executive Officer, Illinois Medical District
STACEY J. ARNESEN, Branch Chief, Disaster Information Management Research Center, National Library of Medicine, National Institutes of Health
ERIC BLANK, Senior Director, Public Health Programs and Systems, Association of Public Health Laboratories
DUANCE C. CANEVA, Chief Medical Officer, U.S. Department of Homeland Security
MARY CASEY-LOCKYER, Senior Associate, Disaster Health Program Development, American Red Cross
BROOKE COURTNEY, Senior Regulatory Counsel, Office of Counterterrorism and Emerging Threats, Food and Drug Administration
JOHN J. DREYZEHNER, Commissioner, Tennessee Department of Health
DAVID EISENMAN, Associate Professor, David Geffen School of Medicine and Fielding School of Public Health, University of California, Los Angeles
BRUCE EVANS, Fire Chief, Upper Pine River Fire Protection District
JAMES R. FICKE, Robert A. Robinson Professor and Director, Department of Orthopaedic Surgery, Johns Hopkins Medicine
LORI GRUBSTEIN, Program Officer, Health Care Group, Robert Wood Johnson Foundation
JOHN L. HICK, Associate Medical Director for EMS and Medical Director of Emergency Medicine, Hennepin County Medical Center
ROBERT KADLEC, Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services
CLAUDIA M. KELLY, Senior Director, Value Access and Policy, Seqirus
THOMAS KIRSCH, Professor of Military and Emergency Medicine, Director, National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences
NICOLETTE A. LOUISSAINT, Executive Director, Healthcare Ready
FREDA GAIL LYON, Vice President, Emergency Services, WellStar Health System
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
PHILLIP MAYTUBBY, Director, Public Health Protection, Oklahoma City-County Health Department
CAROLYN BRADY MEIER, Acting Director, Office of Human Services Emergency Preparedness Response, Administration for Children and Families, U.S. Department of Health and Human Services
AUBREY K. MILLER, Senior Medical Adviser, Office of the Director, National Institute of Environmental Health Sciences, National Institutes of Health
BARBARA MULACH, Director, Office of Science Coordination and Program Operations, National Institute of Allergy and Infectious Diseases, National Institutes of Health
IRA NEMETH, Chair, Disaster Medicine Section, American College of Emergency Physicians
JOHN OSBORN, Operations Manager and Assistant Professor of Health Care Systems Engineering, Department of Surgery, Mayo Clinic College of Medicine
TARA O’TOOLE, Senior Fellow and Executive Vice President, In-Q-Tel
ANDREW T. PAVIA, George and Esther Gross Presidential Professor, Division of Pediatric Infectious Diseases, The University of Utah School of Medicine
TERRY RAUCH, Acting Deputy Assistant Secretary of Defense for Health Readiness Policy and Oversight, Office of the Assistant Secretary of Defense for Health Affairs, U.S. Department of Defense
STEPHEN C. REDD, Director, Center for Preparedness and Response, Centers for Disease Control and Prevention
SARA ROSZAK, Director of Research, National Association of Chain Drug Stores
COLLEEN RYAN, Professor of Surgery, Harvard Medical School
ROSLYNE SCHULMAN, Director, Policy Development, American Hospital Association
RICHARD SERINO, Distinguished Visiting Fellow, National Preparedness Leadership Initiative, Harvard T.H. Chan School of Public Health
ALAN SINISCALCHI, Surveillance Coordinator for Influenza, Bioterrorism, and Public Health Preparedness, Connecticut Department of Public Health
W. CRAIG VANDERWAGEN, Co-Founder and Director, East West Protection
TENER VEENEMA, Professor of Nursing and Public Health, Johns Hopkins University School of Nursing and Johns Hopkins Bloomberg School of Public Health
JENNIFER WARD, President, Trauma Center Association of America
GAMUNU WIJETUNGE, EMS Specialist, Office of Emergency Medical Services, National Highway Traffic Safety Administration, U.S. Department of Transportation
MATTHEW K. WYNIA, Director, Center for Bioethics and Humanities, University of Colorado Denver
Forum Staff
SCOTT WOLLEK, Forum Director
LISA BROWN, Senior Program Officer
BEN KAHN, Associate Program Officer
KIMBERLY SUTTON, Senior Program Assistant
ANDREW M. POPE, Director, Board on Health Sciences Policy
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Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
AMANDA BETTENCOURT, University of Pennsylvania School of Nursing
MARTHA LINET, National Cancer Institute, National Institutes of Health
PHILLIP MAYTUBBY, Oklahoma City-County Health Department
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by HELLEN GELBAND, independent consultant. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Contents
Organization of the Proceedings
2 FEDERAL PLANNING FOR NUCLEAR INCIDENTS
Setting the Stage: Nuclear Detonation Response Planning
Updated Modeling: Nuclear Blasts and Fallout in an Urban Environment
Resources and Capabilities Available at the Federal Level
3 CURRENT STATE OF NUCLEAR PREPAREDNESS
Current State of Medical and Public Health Preparedness for a Nuclear Incident
Workforce Turnover: A Major Challenge to Preparedness
4 UPDATING PLANNING ASSUMPTIONS OF NUCLEAR PREPAREDNESS
Magnitude of Emerging Nuclear Threats
A State-Level Perspective: North Carolina
Regional Response: Opportunities and Challenges
Role of the Private Sector in Preparedness Planning
Fear of Radiation: Implications for Planning
5 IMPLICATIONS OF COMMUNICATION, EDUCATION, AND INFORMATION CHALLENGES
Nuclear Events: Communication, Education, and Information Challenges
Risk Communication in Nuclear Incident Management
A Unique, Video-Based Public Information Campaign: Ventura County, California
Nuclear Incident Public Communication: Tools and Teachable Moments
6 CHALLENGES FOR BUILDING CAPACITY WITHIN THE HEALTH CARE SYSTEM
Priorities for Response Capabilities
Discussion: Shortage of Burn Expertise
7 CAPABILITY-BUILDING CHALLENGES AND OPPORTUNITIES: BUILDING RESPONSE CAPABILITY
Large-Scale Testing for Acute Radiation Sickness After a Nuclear Incident
Use of the Strategic National Stockpile in a Nuclear Scenario
Use of Volunteers During a Nuclear Incident
Role of the U.S. Department of Veterans Affairs in a Nuclear Incident
Community Response Following a Nuclear Event: The Capacity of a Prepared Citizenry
Nuclear/Radiological Incident Annex of FEMA
A U.S. Public Health Service Nurse Perspective
National Disaster Medical System
Provider Knowledge of Disaster Preparedness
Nurse Workforce Readiness for Radiation Emergencies and Nuclear Events
Moderator’s Summary of Overarching Topics
Gaps in Workforce Readiness and Ways to Close Those Gaps
9 BUILDING PREPAREDNESS AND RESPONSE CAPABILITY: LOOKING TO THE FUTURE
ASPR’s Office of Critical Infrastructure Protection
Moving Forward: Priorities Identified by Individuals on the Reaction Panel
Additional Topics Identified by the Audience
10 REFLECTIONS ON THE WORKSHOP AND OPPORTUNITIES FOR MOVING FORWARD
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Acronyms and Abbreviations
| AACN | American Association of Colleges of Nursing |
| ABA | American Burn Association |
| ACS | American College of Surgeons |
| ALC | absolute lymphocyte count |
| AMS | Aerial Monitoring System |
| AO | alert originator |
| AP | advanced practice |
| ARC | American Red Cross |
| ARS | acute radiation sickness |
| ASPR | Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services |
| ASTHO | Association of State and Territorial Health Officials |
| A-Team | Advisory Team for Environment, Food, and Health |
| BARDA | Biomedical Advanced Research and Development Authority |
| BMT | bone marrow transport |
| CBC | complete blood count |
| CBRN | chemical, biological, radiological, and nuclear |
| CDC | Centers for Disease Control and Prevention |
| CEMP | Comprehensive Emergency Management Program, U.S. Department of Veterans Affairs |
| CIP | Healthcare and Public Health Sector Critical Infrastructure Protection Program, Critical Infrastructure Protection, Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services |
| CIR | critical information requirement |
| CMRT | Consequence Management Response Team |
| CMS | Centers for Medicare & Medicaid Services |
| CONOPS | continuity of operations |
| CRC | community reception center |
| DHS | U.S. Department of Homeland Security |
| DoD | U.S. Department of Defense |
| DoE | U.S. Department of Energy |
| DSNS | Division of Strategic National Stockpile |
| EMAC | Emergency Management Assistance Compact |
| EMP | electromagnetic pulse |
| EMS | emergency medical services |
| EOC | emergency operations center |
| EPA | Environmental Protection Agency |
| ESF#15 | Emergency Support Function #15 |
| FCC | Federal Communications Commission |
| FDA | Food and Drug Administration |
| FEMA | Federal Emergency Management Agency |
| FRMAC | Federal Radiological Monitoring and Assessment Center |
| GAO | Government Accountability Office |
| HAP | The Hospital + Healthsystem Association of Pennsylvania |
| HHS | U.S. Department of Health and Human Services |
| HPP | Hospital Preparedness Program |
| ICBM | intercontinental ballistic missile |
| ICU | intensive care unit |
| IND | improvised nuclear device |
| IRB | institutional review board |
| kt | kiloton |
| MDP | Mobile Device Project |
| MERRT | Medical Emergency Radiological Response Team |
| MRC | Medical Reserve Corps |
| Mt | megaton |
| NACCHO | National Association of County & City Health Officials |
| NARAC | National Atmospheric Release Advisory Center, U.S. Department of Energy |
| NARR | National Alliance for Radiation Readiness |
| NCDMPH | National Center for Disaster Medicine and Public Health |
| NDMS | National Disaster Medical System |
| NEST | Nuclear Emergency Support Team, U.S. Department of Energy |
| NHSS | National Health Security Strategy |
| NIH | National Institutes of Health |
| NRF | National Response Framework |
| NRIA | Nuclear/Radiological Incident Annex |
| NRITF | Nuclear/Radiological Incident Task Force |
| NYC | New York City |
| OADN | Organization for Associate Degree Nursing |
| PA | physician assistant |
| PAHPA | Pandemic and All-Hazards Preparedness Act |
| PEMDP | Pre-Event Message Development Project |
| PHEP | public health emergency preparedness |
| PHIT | Public Health Infrastructure Training |
| PSA | public service announcement |
| PSI | pounds per square inch |
| RADM | rear admiral |
| RAP | Radiological Assistance Program |
| RCAC | Risk Communication Advisory Committee |
| RDD | radiological dispersal device |
| RDHRS | Regional Disaster Health Response System |
| REAC/TS | Radiation Emergency Assistance Center/Training Site |
| RED | radiation exposure device |
| RITN | Radiation Injury Treatment Network |
| RN | registered nurse |
| RSL | Remote Sensing Laboratory |
| SMS | short message service |
| SMS-CB | short message service-cellular broadcast |
| SNS | Strategic National Stockpile |
| START | Study on Terrorism and Responses to Terrorism |
| TNT | trinitrotoluene |
| USPHS | U.S. Public Health Service |
| VA | U.S. Department of Veterans Affairs |
| WEA | wireless emergency alert |
| WHO | World Health Organization |
| WMD | weapon of mass destruction |
Dedication
This Proceedings of a Workshop is dedicated to our science writer Leslie Pray (1964–2018). Leslie worked for many years as a science writer with the National Academies, and our staff will always remember her kind nature, skillful writing, and sharp intellect.
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