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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8 Reorienting and Augmenting Professional Approaches
8 Reorienting and Augmenting Professional Approaches
Pages 71-80
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From page 71... ...
x If the incident commander decides that high radiation doses to emer gency workers are justified, the workers must be made aware of the doses and the adverse health consequences in order to give informed consent before proceeding with the rescue mission. Throughout the workshop it was evident that many federal resources are available to assist communities, including recently developed systems and technology to give local jurisdictions and responders on the ground a better common operating picture and improved situational awareness.
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From page 72... ...
x Decontamination x Transport of victims, many of whom are candidates for the Radi ation Injury Treatment Network's (RITN's) specialty care As another system to assist state and local entities in response, Coleman and colleagues also developed a tool called MedMap, also mentioned in Chapter 5, which is used for obtaining situational awareness for responding authorities at the site as well as at the federal level in order to coordinate resources.
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From page 73... ...
Coleman also noted that other features can be loaded into MedMap, including hospital occupancy rates, RITN hospitals, nursing homes, schools, Veterans Administration hospitals, weather, and the locations of sites stocked with medical countermeasures. As John Hick of Hennepin County Medical Center mentioned in Chapter 2, patients with acute radiation syndrome (ARS)
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From page 74... ...
When responding to an IND event, scarce resources will be the norm. According to MORTT, triaging moderately injured victims first, then the severely injured victims, followed by the mildly injured (Mod-Sev-Mild)
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From page 75... ...
Deciding on the triage approach for scarce resources requires a difficult conversation and needs community agreement and attention before an incident through preplanning and interactive public discussions. MENTAL HEALTH IMPLICATIONS OF AN IND Ann Norwood, a senior associate at the UPMC Center for Health Security, addressed the role of mental health providers in an outlying community approximately 2 weeks post-detonation.
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From page 76... ...
If such people seek medical help, the first responder or clinician should avoid referring them to a mental health provider. Making a psychiatric referral signifies to these patients that their symptoms are being discounted and they are "all in their head." From a mental health perspective, an IND attack is more difficult to respond to than other disasters for several reasons: Radiation is highly feared; it is undetectable to the senses (leaving people ignorant about where they can retreat to for safety)
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From page 77... ...
Most responders lack training in radiation safety, which likely contributes to the research finding that responders are often reluctant to respond to an event involving significant radiation hazards. Another challenge is to train responders to understand that the severe damage zone has not only radiological hazards, but also numerous physical and chemical hazards, including collapsed structures, heat and fire, broken glass and sharp objects, and downed power lines and ruptured gas lines.
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From page 78... ...
. If the incident commander decides that doses above 50 rads to emergency workers are justified, the workers must be made aware of the doses and the adverse health consequences in order to make informed decisions about proceeding with the rescue mission (NCRP, 2010; OSTP, 2010)
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From page 79... ...
Triaging moderately injured victims first saves 10 percent more lives than triaging severely injured first when resources are limited. Attending to the mental health needs of injured and healthy alike is critical to preventing distress and the development of mental disorders like posttraumatic stress disorder and depression, which are highly preva 2 See http://nrt.sraprod.com/erhms (accessed May 12, 2013)
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From page 80... ...
Because the limit was designed for nuclear accidents, DHS modified the policy to also deal with nuclear terrorism. The new policy does not set an upper limit on dose, but rather sets a dose of 50 rads as a "decision dose" requiring incident managers to make a decision about whether to evacuate responders from the area.
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