Planners:
Information for Radiation Emergencies
Introduction
- Disaster response plans describe how various governmental and private sector entities are supposed to function individually and collaboratively during a disaster in order to protect the public and key infrastructure and continue to perform their missions.
- Hospitals, public health agencies and other health entities also have response plans specific for their missions.
- Planning details
- Some plans are appropriate for all types of incidents: "all hazard" plans.
- Some plans are hazard-specific e.g., chemical, biological, radiological, nuclear, natural disasters
- Hazard-specific response plans typically contain the critical elements of "all hazard" plans but also include modifications that address hazard-specific features
- Effective plans are
- Developed collaboratively by all potential participants
- Integrated into plans that will be used by others participating in the response
- Communicated to all those who will perform activities specified by the plan
- Practiced in formal drills or exercises
- Updated regularly to reflect lessons learned in formal exercises
- The nature, scope, and location of a mass casualty disaster will significantly affect the implementation of any response plan.
- The documents featured below provide an overview of some of the current key documents relevant to medical response planning. The list is not exhaustive.
- If you are new to the planning process, please refer to pre-existing documents for your jurisdictions and workplace.
- Preparedness in context
- In 2013, the Institute of Medicine published a workshop summary reviewing Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions.
- In 2011, the Nuclear Detonation Scarce Resources Working Group published a series of manuscripts about medical and public health planning and response to a nuclear disaster with scarce resources. (DMPHP, March 2011)
- HHS/ASPR guidance about planning and preparedness
- Medical practice, standards of care, available assets, Concept of Operations, and liability issues are complex, and each practitioner should consult with experts in his/her venue and organization.
- 2017 – 2022 Health Care and Preparedness and Response Capabilities (PDF - 795 KB) (HHS/ASPR, November 2016)
- HHS/ASPR recognizes that there is shared authority and accountability for the health care delivery system's readiness that rests with private organizations, government agencies, and Emergency Support Function-8 (ESF-8, Public Health and Medical Services) lead agencies.
- Given the many public and private entities that must come together to ensure community preparedness, HCCs serve an important communication and coordination role within their respective jurisdiction(s).
- Evidence-Based Practice for Public Health Emergency Preparedness and Response, Consensus Study Report (National Academies of Sciences Engineering and Medicine, 2020)
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Key Federal Disaster Response Planning Documents
-
From the President of the United States
- From the US government
- National Planning Frameworks
- Prevention
- Mitigation
- Disaster Recovery
- Protection
- Federal Interagency Operational Plans
- Community Recovery Management Toolkit
- Urban Search and Rescue
- Training and Education
- National Preparedness Goad
- National Incident Management System
- Exercises
- Community Resources
- 2020 National Preparedness Report (PDF - 15.8 MB) (DHS December 2020)
- National Preparedness Resource Library: includes all the documents that together constitute the National Response Framework
- Other health related national security policy documents
- Protection of "Cybersecurity and Critical Infrastructure" including the Healthcare and Public Health Sectors
-
National Incident Management System (NIMS)
- Incident Command System (ICS) is one part of the National Incident Management System (NIMS)
- FEMA resources about ICS
- Continuity of Operations (COOP)
-
Emergency Use Authorization of Medical Products (HHS/FDA)
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Key US Radiation-Specific Response Plans
- Nuclear/Radiological Incident Annex to the Response and Recovery Federal Interagency Operations Plan (US Government Interagency, 2023)
- A Decision Makers Guide: Medical Planning and Response for a Nuclear Detonation (HHS/ASPR, November 2017)
- PAG Manual: Protective Action Guides and Planning Guidance for Radiological Incidents, EPA-400/R-17/001 (PDF - 1.48 MB) (EPA, January 2017)
- Response and Recovery Knowledge Product: Key Planning Factors for Recovery from a Radiological Terrorism Incident (PDF - 7.48 MB) (DHS/FEMA, September 2012)
- Coleman CN, Sullivan JM, Bader JL, Murrain-Hill P, Koerner JF, Garrett AL, Weinstock DM, Case C Jr, Hrdina C, Adams SA, Whitcomb RC, Graeden E, Shankman R, Lant T, Maidment BW, Hatchett RC. Public health and medical preparedness for a nuclear detonation: the nuclear incident medical enterprise. Health Phys. 2015 Feb;108(2):149-60. [PubMed Citation]
- Coleman CN, Blumenthal DJ, Casto CA, Alfant M, Simon SL, Remick AL, Gepford HJ, Bowman T, Telfer JL, Blumenthal PM, Noska MA, Recovery and Resilience After a Nuclear Power Plant Disaster: A Medical Decision Model for Managing an Effective, Timely, and Balanced Response, Dis Med Pub Health Prep 2013;7(2),2013. [PubMed Citation]
- Nuclear Terrorism Response Plans: Major Cities Could Benefit from Federal Guidance on Responding to Nuclear and Radiologic Attacks. GAO-13-736 (U.S. Government Accountability Office, Sept 30, 2013)
- Coleman CN, Adams S, Adrianopoli C, Ansari A, Bader JL, et al., Medical planning and response for a nuclear detonation: a practical guide. Biosecur Bioterror. 2012 Dec;10(4):346-71. [PubMed Citation]
- Decision Making for Late-Phase Recovery from Major Nuclear or Radiological Incidents, (NCRP Report No. 175), National Council on Radiation Protection and Measurements, Bethesda, MD, 2014.
- The Nuclear Detonation Scarce Resources Working Group has published a series of manuscripts about medical and public health planning and response to a nuclear disaster with scarce resources. (DMPHP, March 2011)
- State and Local Planners Playbook for Medical Response to a Nuclear Detonation (HHS/ASPR, March 2011)
- Responding to an RDD / RED Emergency: the HHS Playbook, guidance for executive decision makers within the Department of Health and Human Services (HHS) in the event of an actual radiological terrorist attack in a U.S. city. (HHS/ASPR, April 2010)
- Planning Guidance for Response to a Nuclear Detonation, Second edition, 6/2010 (PDF - 2.62 MB) (National Security Staff, Interagency Policy Coordination Subcommittee for Preparedness & Response to Radiological and Nuclear Threats)
- See also: Develop a Radiation Response Plan
- See also: Equip an Emergency Department for Decontamination
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State, Territorial, Tribal, and Local Government Disaster Response Planning
Radiation Incident Plans
- New York City
- Federal
- HHS
- A Decision Makers Guide: Medical Planning and Response for a Nuclear Detonation (HHS/ASPR, November 2017)
- State and Local Planners Playbook for Medical Response to a Nuclear Detonation (HHS/ASPR/OPEO/OPP, March 2011)
- Medical Planning and Response Manual for a Nuclear Detonation Incident: A Practical Guide (PDF - 7.87 MB) (HHS)
- Coleman CN, Adams S, Adrianopoli C, Ansari A, Bader JL, et al., Medical planning and response for a nuclear detonation: a practical guide. Biosecur Bioterror. 2012 Dec;10(4):346-71. [PubMed Citation]
- Hrdina CM, Coleman CN, Bogucki S, Bader JL, Hayhurst RE, Forsha JD, Marcozzi D, Yeskey K, Knebel AR. The "RTR" medical response system for nuclear and radiological mass-casualty incidents: a functional TRiage-TReatment-TRansport medical response model. Prehosp Disaster Med. 2009 May-Jun;24(3):167-78. [PubMed Citation]
- The Nuclear Detonation Scarce Resources Working Group has published a series of manuscripts about medical and public health planning and response to a nuclear disaster with scarce resources. (DMPHP, March 2011)
- Other
All Hazards Plan
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Incident Command System and Hospital Incident Command System
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Selected National and International Radiation Event-specific Response Planning Documents
- Preparedness and Response for a Nuclear or Radiological Emergency, (IAEA, GSR part 7 and International Partners, 2020)
- Preparedness and Response for a Nuclear or Radiological Emergency, IAEA Safety Standards Series GSR part 7 (Jointly sponsored by IAEA and 12 other organizations noted on cover page, 2015)
- Radiation Health Response Plan (PDF - 4.54 MB) (Emergency Management Branch, Ministry of Health and Long Term Care, Ontario, Canada, 2014)
- This excellent document describes how Ontario, Canada’s health system plans to respond to a radiological/nuclear incident of deliberate or accidental nature, and the conditions under which precautionary and protective actions are implemented for the general public and health system
- Also provides links to Ontario’s plans for using KI
- Operations Manual for Incident and Emergency Communication: Emergency Preparedness and Response (IAEA, 2013)
- Nationwide Response Issues after an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: An Institute of Medicine Workshop
- Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health considerations for Neighboring Jurisdictions: Workshop Summary (Institute of Medicine, 2014)
- In the right navigation panel of the web page, see
- Agenda
- Presentations
- Attachments: white papers on key policies
- Audio
- IAEA Response and Assistance Network (RANET) (IAEA)
- Provides international assistance, upon request from a State, following a nuclear or radiological incident or emergency
- Radiation Injury Treatment Network Concept of Operations — This document outlines the anticipated integration of the Radiation Injury Treatment Network® (RITN) into the national response to a mass casualty incident resulting in marrow-toxic injuries
- Joint Radiation Emergency Management Plan of the International Organizations (European Commission, Europol, FAO, IAEA, INTERPOL, IMO, OECD/NEA, PAHO, UNEP, UN/OCHA, UN/OOSA, WHO, WMO, ICAO, UNSCEAR, January 1, 2010) (PDF - 1.57 MB)
- International Agency for Atomic Energy (IAEA)
- Triage, Monitoring and Treatment of people exposed to ionising radiation following a malevolent act (PDF - 11 MB) (TMT Handbook Partners, March 2009)
- Assessing Medical Preparedness to Respond to a Terrorist Nuclear Event. Workshop Report. (Institute of Medicine of the National Academies. June 15, 2009. Purchase required.)
- Public Health Preparedness and Response to Chemical and Radiological Incidents — Functions, Practices, and Areas for Future Work (RAND Corporation, 2009, TR-719-DHHS)
- Key Response Planning Factors for the Aftermath of Nuclear Terrorism (PDF - 4.52 MB) (Lawrence Livermore National Laboratory, August 2009)
- Musolino SV, DeFranco J, Schlueck R. The ALARA principle in the context of a radiological or nuclear emergency. Health Phys. 2008 Feb;94(2):109-11. [PubMed Citation]
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Planning and Informational Platform
- Technical Resources, Assistance Center, and Information Exchange (TRACIE): Healthcare Emergency Preparedness Information Gateway (HHS/ASPR)
- Created to meet the information and technical assistance needs of regional ASPR staff, healthcare coalitions, healthcare entities, healthcare providers, emergency managers, public health practitioners, and others working in disaster medicine, healthcare system preparedness, and public health emergency preparedness.
- Science Preparedness (HHS/ASPR) — Scientific research framework that can enable emergency planners, responders and the whole community to better prepare for, respond to, and recover from major public health emergencies
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Incident Registry for Victims and Responders
- Radiation incidents, both large and small, have potential short and long term consequences for those actually involved (victims and responders) and those who remain concerned about the incident.
- Registries of those affected can be implemented in various ways by governments and other entities. Privacy and security issues must be respected.
- Registries can contribute to
- Lessons learned
- Improved plans for the future
- Appropriate medical follow-up: design and implementation
- Advancement of scientific inquiry: identified and addressed
- Improvement of radiation protection and safety protocols
- There is a long history of formal epidemiologic, legal, and forensic follow-up of prior radiation incidents of all kinds.
- Creation of registries will assist with these endeavors.
References
- Long-Term Health Monitoring of Populations Following a Nuclear or Radiological Incident in the United States, Proceedings of a Workshop (NASEM, 2019)
- Reviews the process for preparing a radiation registry for monitoring long-term health effects of populations affected by a nuclear or radiological incident.
- Assesses existing information, useful practices, and tools for planning a radiation registry that will enhance incident monitoring and response methods.
- A Framework for Assessing Mortality and Morbidity after Large-Scale Disasters, Consensus Study Report (NASEM, 2020)
- Reviews and describes the current state of the field of disaster-related mortality and significant morbidity assessment.
- Examines practices and methods for data collection, recording, sharing, and use across state, local, tribal, and territorial stakeholders; evaluates best practices.
- Identifies areas for future resource investment.
- See REMM information about sample data elements useful in radiation incident registries
- Piltch-Loeb R, Kraemer JD, Nelson C, Stoto MA. A public health emergency preparedness critical incident registry. Biosecur Bioterror. 2014 May-Jun;12(3):132-43. [PubMed Citation]
- Humanitarianism in the Age of Cyber-warfare: Toward the Principled and Secure Use of Information in Humanitarian Emergencies. (PDF - 1.17 MB) (United Nations Office for the Coordination of Humanitarian Affairs. OCHA Policy and Studies Series, October 2014)
- See also: Data Elements to Collect During Radiation Emergencies
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US Military
- Chemical, Biological, Radiological, and Nuclear Consequence Management, Joint Publication 3-41 (PDF - 2.08 MB) (Joint US Military, Sept 9, 2016)
- US Military Books
- O'Connor FG, Schoomaker EB, Smith DC, eds.: Fundamentals of Military Medicine. Office of the Surgeon General, Borden Institute, US Army Medical Department, 2019.
- Mickelson AB, ed., Medical Consequences of Radiological and Nuclear Weapons, Textbook of Military Medicine series; Office of the Surgeon General, Department of the Army, United States of America, Falls Church, VA, and Borden Institute, Fort Detrick, Maryland, 2012.
- Effects of Nuclear Earth-Penetrator and Other Weapons, Consensus Study Report, 2005, Committee on the Effects of Nuclear Earth-Penetrator and Other Weapons: Division on engineering and Physical Sciences, National Research Council of the National Academies
- Walker RI, Cerveny TJ, eds.: Medical Consequences of Nuclear Warfare. In: Zajtchuk R, Jenkins DP, Bellamy RF, Ingram VM, eds.: Textbook of Military Medicine. Part I, Vol. 2, Falls Church, VA: Office of the Surgeon General, Department of the Army, United States of America, April 1989, 473 pages) (Download pdf of book )
