Transcript Public Health Considerations in a Radiological/Nuclear Event

An Update on Population
Monitoring Activities at CDC
Charles W. Miller, PhD
Armin Ansari, PhD, CHP
Radiation Studies Branch
Division of Environmental Hazards & Health Effects
National Center for Environmental Health
Centers for Disease Control & Prevention
Atlanta, Georgia
Overview
• What is “Population monitoring”?
• Who is responsible for it?
• Federal agency support, roles,
responsibilities
• CDC’s efforts in the area of population
monitoring
• What next?
Potential Nuclear/Radiological
Incidents
•
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Transportation
Power Plant
Weapons
Laboratory
Industrial
Medical
Space
Terrorism
Terrorism Scenarios
• IND – Improvised Nuclear Device
• RDD – Radiological Dispersal Device
– may or may NOT involve explosion
• RED – Radiological Exposure Device
A device whose purpose is to expose
people to radiation, rather than to disperse
radioactive material. “silent source”
Population
Monitoring
The process of identifying, screening, and
monitoring people for exposure to
radiation or contamination with radioactive
materials.
Population
Monitoring
Evaluate potentially-affected population for:
– Needed medical treatment (both rad and non-rad
related)
– Presence of contamination on body or clothing.
– Intake of radioactive materials
– Removal of external or internal contamination
(decontamination)
– Radiation dose received and the resulting health
risk from the exposure
– Long-term health effects (registry)
Potential Impacts
• Nuclear Detonation
– Hundreds of thousands of fatalities
– Hundreds of thousands contaminated
• Explosive Radiological Dispersal
Device
– Hundreds of fatalities
– Thousands contaminated
American Red Cross
Sheltering/Contamination Issues
During the TOPOFF 2
exercise in Seattle, WA
in 2003…
“Before evacuated
residents could enter
the shelter, they first
had to be examined
for radioactive
material”
http://www.redcross.org/article/0,1072,0
_332_1153,00.html
Citizens Have Radiation
Monitoring Instruments
Current Planning Guidance
The Federal Emergency
Management Agency has exercise
evaluation criteria requiring that
state emergency response plans
demonstrate the ability to monitor
20% of the potentially exposed
population within 12 hours upon
arrival at a relocation center.
Reference: “Criteria for Preparation and Evaluation of Radiological
Emergency Response Plans and Preparedness in support of Nuclear
Power Plants” NUREG-0645 FEMA-REP-1 Rev 11)
How is this demonstrated?
For nuclear power facilities, affected
populations could range from a few
hundred to several hundred thousand
individuals. Most state and local health
departments attempt to demonstrate
this with:
– Hand-held radiation survey instruments
– Portal monitors (for only beta/gamma
monitoring) are used by only a handful of
state agencies (the DOE has 13 deployable
with the FRMAC assets)
– Alpha portal monitors have limited
capabilities and are not easily transportable
External only
National Response
Framework
Nuclear/Radiological Incident
Annex
Decontamination/Population Monitoring
are:
“the responsibility of State, local, and
tribal governments.”
National Response
Framework
Nuclear/Radiological Incident Annex
HHS, through ESF #8 and in consultation
with the coordinating agency, coordinates
Federal support for external monitoring of
people and decontamination.
– Department of Energy responsible for
equipment and personnel
National Response
Framework
Nuclear/Radiological Incident Annex
HHS assists and supports State, local,
and tribal governments in performing
monitoring for internal contamination and
administering available pharmaceuticals
for internal decontamination, as deemed
necessary by State health officials.
National Response
Framework
Nuclear/Radiological Incident Annex
HHS assists local and State health
departments in establishing a registry of
potentially exposed individuals, performing
dose reconstruction, and conducting longterm monitoring of this population for
potential long-term health effects.
Current State/Federal Capabilities*
• External monitoring
Marginal
• Internal monitoring
• Bioassay
• Biodosimetry
Extremely limited
*States with nuclear power plants
somewhat better prepared.
CDC’s Approach to
Nuclear/Radiological Preparedness
• Determine what State, tribal and local
public health agencies need
• Develop and test products that address
those needs
• Prepare to successfully implement
CDC’s responsibilities to support State,
tribal and local officials
CDC Efforts to Date
• January 2005 – Population Monitoring
Roundtable
September 2005 – Roundtable Report Posted
http://emergency.cdc.gov/radiation
• March 2006 –Satellite broadcast
“Preparing for Radiological Population Monitoring
and Decontamination”
• August 2007 - CDC posted draft population
monitoring guidance based on input from a
number of sources
• CDC is currently developing rapid
radioanalytical laboratory capacity
Laboratory Analyses
• Conventional methodology
– 24-hr urine sample
– 3-7 days turnaround time
– 5-40 samples/day/lab
• Improved methodology (for population
screening)
– 1-50 ml “spot” sample
– 4-36 hours turnaround time (multiple radionuclides)
– 100-500+ samples/day/lab
• Field screening and prioritization important
• Increase number of public health laboratories
capable of doing such analyses
Radiation Instruments in
Hospitals
To screen patients for internal
contamination
– Thyroid Scanners
• Feasible and practical
– Gamma Cameras
• Not for large numbers
An Evaluation of Hospital Radiation Detectors for Use
in Screening Potentially Contaminated Individuals
http://emergency.cdc.gov/radiation
CDC Guidance
• Target audience:
– State and local
public health and
emergency
preparedness
personnel
• Focus
– Incidents involving
mass casualties
• Scope
– Assumes local
infrastructure is
intact
– Principles apply to
all radiation
incidents
Purpose
• State/local emergency response and
public health authorities can use this
Guide to:
– Evaluate their emergency response plans
– Identify/prioritize staffing needs, training
requirements, and necessary material
assets.
– Further develop mutual assistance
programs
– Be better prepared to prioritize allocation of
existing resources in actual response
Guiding Principles
• The first priority is to save lives: respond to
and treat the injured first.
• Contamination with radioactive materials is
not immediately life-threatening.
• Initial population monitoring activities should
focus on preventing acute radiation health
effects.
– Cross contamination issues are a secondary
concern
Guiding Principles (CONT.)
• Scalability and flexibility are an
important part of the planning process.
• The State radiation control program is a
key resource for implementing the
plans outlined in this guide.
– Establish relationships with other
radiation experts/resources in the
community (hospitals, universities, etc.)
Current Status
• Population Monitoring Planner Guide
available from:
http://emergency.cdc.gov/radiation
• Draft for comment
• Your feedback would be appreciated!!
Community Reception Centers
• Local response strategy for conducting
population Monitoring
• Multi-agency effort, public health lead
• Staffed by government officials and
organized volunteers
• Opened 24-48 hours post event
• Located outside of “hot zone”
Community Reception Centers
• Services include:
– Screening for radioactive contamination
– Assistance with decontamination
– Limited medical care
• Prioritize people for further care
– Ease burden on hospitals
– Manage scarce medical resources
• Comparable to
– Neighborhood Emergency Help Centers (NEHC) or
– Point of Dispensing (POD)
Community Reception Center
Process Flow
• 6 Main Process
Areas
– Initial Sorting
– Emergency Medical
Care or Transfer
– Survey and
Monitoring
– Wash Station
– Registration and
Dose/Medical
Assessment
– Discharge
CRC
Process Flow
• Process can be adjusted to meet existing
capabilities
– Instrumentation
– Personnel
• There is an “express” lane for people who have
cleaned at home.
• There is an additional module for a “pet-friendly”
reception center.
• Other processes can be added as needed or as
possible
– e.g., relocation services
Work in Progress
• CRC-STEP
– Community Reception Center Simulation Tool for
Evaluation and Planning
– Excel-based interface for modeling staffing and
equipment resources and evaluating throughput.
• RealOpt-CRC
– Optimization tool for maximizing throughput
• Both decision tools are easy to use
• User Manuals for both along with short tutorial
video on the web will be prepared.
CRC-STEP
Simulation Tool for Evaluation and Planning
• Excel Interface
• Customizable
for Basic and
Advanced
Users
• Runtime
Animation
RealOpt CRC
Optimization Software
•
Free, no runtime license required.
Work Just Begun
Web-based training tool on CRC operations with
detailed accompanying documentation and resources
Challenge:
Adequate staffing for CRC
• Motivate the country’s large health
physics, medical physics, and nuclear
medicine community to enlist in a
locally-sponsored volunteer registry.
• CDC is leading a nationwide effort to
organize radiation professional
volunteers into existing health
volunteer registries.
Radiation Response Volunteer Roundtable
February 10-11, 2009, Atlanta, GA
• Invitees included representatives from:
– ESAR-VHP (Emergency System for the Advance
Registration of Volunteer Health Professionals)
– MRC (Medical Reserve Corps)
– Professional societies:
• HPS, NRRPT, AAPM, SNM, ASTRO
– CRCPD
– Several state health and EM organizations involved in
radiation volunteer registries
• Attendees developed an action plan for establishing
roles and training requirements for radiation
protection volunteers who could be used for
population monitoring for large-scale events in the
United States.
Summary
• “All emergencies are local”
• Future terrorist events cannot
be dismissed
• These events may involve
radiological components
• Population monitoring will be a
key component in the public
health response to any such
event
THANK YOU
http://emergency.cdc.gov/radiation
Radiation Studies Branch, CDC
[email protected]
(770) 488-3800
Charles W. Miller
770-488-3725
[email protected]