terrorist nuclear detonation of 10 kilotons would have catastrophic physical, medical, and psychological consequences and could be accomplished with a device in a small truck. Tens of thousands of injured and ill survivors and uninjured, concerned citizens would require medical care or at least an assessment and instructions. In proximity to the incident location, there would be a huge imbalance between the demand for medical resources and their availability. 1-3 Beyond the immediate blast area, much of the infrastructure would remain intact. Most people would reach medical care by selfreferral and require sorting and assessment to determine what medical intervention is necessary, appropriate, and possible. No society has the resources to deliver the full spectrum of care needed in the time frame required. Yet, careful planning and a clear understanding of how best to allocate scarce resources, triage and evacuate patients, and implement crisis standards of care have the potential to save thousands of lives and provide comfort to those unlikely to survive. The US government and nongovernment experts continue to develop planning guidance, 1,4-8 medical countermeasures, 9,10 and medical specialty capacity and capabilities. 11-13 This Scarce Resources for a Nuclear Detonation Project provides data, supporting information, and tools for medical planners and responders to address the issues of scarce resources 14 and plan for triage and resource allocation in the first 4 days postdetonation, when there will be severe shortages.

No abstract

ABSTRACTThis article summarizes public health legal issues that need to be considered in preparing for and responding to nuclear detonation. Laws at the federal, state, territorial, local, tribal, and community levels can have a significant impact on the response to an emergency involving a nuclear detonation and the allocation of scarce resources for affected populations. An understanding of the breadth of these laws, the application of federal, state, and local law, and how each may change in an emergency, is critical to an effective response. Laws can vary from 1 geographic area to the next and may vary in an emergency, affording waivers or other extraordinary actions under federal, state, or local emergency powers. Public health legal requirements that are commonly of concern and should be examined for flexibility, reciprocity, and emergency exceptions include liability protections for providers; licensing and credentialing of providers; consent and privacy protections for patients; occupational safety and employment protections for providers; procedures for obtaining and distributing medical countermeasures and supplies; property use, condemnation, and protection; restrictions on movement of individuals in an emergency area; law enforcement; and reimbursement for care.(Disaster Med Public Health Preparedness. 2011;5:S65-S72)

This article discusses the steps that the Department of Health and Human Services follows to authorize emergency use of products under section 564 of the Federal Food, Drug and Cosmetic Act through Emergency Use Authorizations. We provide examples of when the department might authorize such emergency use and describe the products for which the department has authorized emergency use for the current H1N1 influenza pandemic as of September 1, 2009.

No abstract