Nationwide Response Issues After an Improvised Nuclear Device Attack Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary (2014) / Chapter Skim
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H Implications of an Improvised Nuclear Device Detonation on Command and Control for Surrounding Regions at the Local, State, and Federal Levels A white paper prepared for the January 23–24, 2013, workshop on Nationwide Response to an Improvised Nuclear Device Attack, hosted by the Institute of Medi cine's Forum on Medical and Public Health Prepared ness for Catastrophic Events together with the National Association of County and City Health Officials. The au thor is responsible for the content of this article, which does not necessarily represent the views of the Institute of Medicine.
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192 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK implement a successful response. The scope of this white paper is to address the following questions: x Would the current command and control framework change in the face of an IND incident?
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APPENDIX H 193 sponse to an IND detonation are presented here. There is no single solution for each of these challenges that is appropriate for all jurisdictions and plans, nor are the potential solutions presented here intended to be taken as federal guidance.
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194 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK pact primary transportation corridors and critical infrastructure. Even in the neighboring jurisdictions, some of the general population may try to self-evacuate the area, resulting in gridlock situations.
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APPENDIX H 195 Unified Command The Unified Command structure required for effective command and control of an IND response must reflect the needs of the jurisdiction and be based on operational requirements. Representation from all partners with jurisdictional or operational authority will be required.
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196 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK Complex Multiple incidents managed by a single incident command, a single Unified Command, or a single incident management team (IMT) are referred to as a "Complex" (NWCG, 2004)
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APPENDIX H 197 negative, on the population. Commanders will be tasked with analyzing available incident information and developing initial incident action plans based upon the needs of their population and available resources.
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198 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK transport providers, health care, Red Cross, shelters, etc.? What level of contamination will be accepted by receiv ing facilities and those providing transport services around the nation?
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APPENDIX H 199 those from all typical and atypical resources. Data that will assist command and control with incident planning should include x Radiation reports, with location o Radiation levels (dangerous fallout zone, hot zone, or cold zone)
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200 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK FIGURE H-1 Multiagency Coordination (MAC) system.
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APPENDIX H 201 How Would Public Health and Medical Services Fit into the Command and Control Structure? Involvement of public health and medical services early in the preplanning and response phase for an IND will be a key factor in successful command and control operations.
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202 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK be developed and agreed upon by transport providers, receiving facilities, and cities. A policy should be developed that ensures that when there is a demand for service and a lack of resources that no longer allow conventional patient care, CSC methods be implemented.
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APPENDIX H 203 who do not have the advantage of frequent emergency operations. Jurisdictions should be encouraged to incorporate newly developed response plans and policies into "everyday operations" to increase operational preparedness and capabilities.
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204 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK Regulatory Issues A significant area to be addressed in the planning efforts should be the requirement to deal with regulatory and policy concerns. As described in the DHS National Preparedness Goal, legal, policy, and regulatory waivers/exemptions/exceptions will be required to achieve many of the operational targets selected by command and control.
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APPENDIX H 205 o The concept of "clean enough for now" should be considered in order to maintain the flow of patients, commerce, and re sponse operations to support the incident o Different decontamination requirements between medical fa cilities, transport providers, and emergency medical services could prevent the efficient transfer or transport of patients from one facility to the next o Equipment or vehicles that would normally be thoroughly decontaminated before reuse will need to be used with limited or no decontamination, especially if the risk from the contamination is offset by the gain in continuing the operation o In the early days of the response, low-level cross contamina tion from people, vehicles, and equipment leaving the con taminated areas will be widespread and should not prevent or stop necessary operations o Consistent guidelines should be adopted before the incident o These guidelines should include scalable action levels for contamination that become more stringent as the urgency decreases and resources increase x Personal protective equipment (PPE) ; a framework for assessing the need for and the selection of PPE for responders, public health, private-sector workers, and volunteers should be devel oped, to include o Minimum standards for respiratory protection related to ra diation and debris dust issues o Discipline-specific needs o Job-specific needs x Action levels for dose, including first responders, public health, and other response assets that will participate in an IND response x Action levels for dose rate o Planning Guidance for Response to a Nuclear Detonation (EOP, 2010)
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206 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK The adoption of PPE standards should include language allowing for a scaled approach. These standards would provide command and planning staffs the flexibility to establish a response and refine operations as time and resources allow.
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APPENDIX H 207 FIGURE H-2 Example of victim/patient flow. Graphic Credit: NSTec/CTOS.
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208 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK diation health and safety issues for an IND response. Once solutions are determined, they should be incorporated into jurisdiction policies and procedures.
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APPENDIX H 209 Rather than having multiple ICPs and EOCs sending similar questions to many different federal agency contacts, questions and requests for advice/recommendations can be routed through the state EOC to the Advisory Team. As the Advisory Team provides responses, the state EOC can distribute the information to all operational EOCs.
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210 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK REFERENCES Buddemeier, B., J Valentine, K
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APPENDIX H 211 National Security Technologies, CTOS-Center for Radiological/Nuclear Train ing at the Nevada National Security Site, 2013. Key Leader Training -- Incident Commander IND Response Program: Course 1–Initial Actions, Version 0.1 Draft [Web-based training]
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