Medical Response to a Nuclear Detonation: Creating a Playbook for State and Local Planners and Responders

Abstract

<jats:title>ABSTRACT</jats:title><jats:p>For efficient and effective medical responses to mass casualty events, detailed advanced planning is required. For federal responders, this is an ongoing responsibility. The US Department of Health and Human Services (DHHS) prepares playbooks with formal, written plans that are reviewed, updated, and exercised regularly. Recognizing that state and local responders with fewer resources may be helped in creating their own event-specific response plans, subject matter experts from the range of sectors comprising the Scarce Resources for a Nuclear Detonation Project, provided for this first time a state and local planner's playbook template for responding to a nuclear detonation. The playbook elements are adapted from DHHS playbooks with appropriate modification for state and local planners. Individualization by venue is expected, reflecting specific assets, populations, geography, preferences, and expertise. This playbook template is designed to be a practical tool with sufficient background information and options for step-by-step individualized planning and response.</jats:p><jats:p>(<jats:italic>Disaster Med Public Health Preparedness</jats:italic>. 2011;5:S89-S97)</jats:p>

A Translatable Predictor of Human Radiation Exposure

“…The threat of terrorism via detonation of radiological weapons or improvised nuclear devices remains a major public health and national security concern in the United States [1]–[4]. While federal, state and private institutions have marshaled resources and expertise to prepare a medical response for a radiological mass casualty event, a major gap remains in the tools available to health care providers for biodosimetry [4]–[12].…”

“…In the past decade, substantial efforts have been made in the federal, state and private sectors to prepare for an effective medical response in the event of a radiation disaster in a U.S. city [4], [5]. As illustrated in the aftermath of the Fukushima power plant accident, the threat of exposure to even a relatively small amount of ionizing radiation can have paralyzing effects on a global scale [6].…”

Scarce Resources for Nuclear Detonation: Project Overview and Challenges

“…The resulting articles in this special issue of Disaster Medicine and Public Health Preparedness are not intended to be exhaustive reviews, and they reflect the judgment and opinion of the experts, not those of the governmental agencies or academic institutions that employ them. [14][15][16][17][18][19][20][21][22] The recommendations are based on the available data, recognizing that the human and animal data on radiation injury alone and on combined injury are limited.…”

“…The resulting articles in this special issue of Disaster Medicine and Public Health Preparedness are not intended to be exhaustive reviews, and they reflect the judgment and opinion of the experts, not those of the governmental agencies or academic institutions that employ them. [14][15][16][17][18][19][20][21][22] The recommendations are based on the available data, recognizing that the human and animal data on radiation injury alone and on combined injury are limited.Model output for casualty types and number are described in a general manner. 15 (The Department of Health and Human Services has detailed models from which the data and guidance in these articles are based for the consequences of nuclear detonation in a range of cities, from a variety of heights of burst, and under a range of meteorological conditions, and for scarcity of specific resources for medical management of acute radiation syndrome.…”

Mapping Radiation Injury and Recovery in Bone Marrow Using 18F-FLT PET/CT and USPIO MRI in a Rat Model

“…Furthermore, in radiotherapy for cancer patients, bone marrow (BM) toxicity can be a limiting factor in determining therapeutic radiation doses. Although medical imaging is at the forefront of early diagnosis of disease and patient triaging, imaging is not yet an integrated tool in emergency preparedness plans in response to a nuclear disaster (3). In this article, we address this issue by making use of 39-deoxy-39- 18 F-fluorothymidine ( 18 F-FLT) PET/CT and ultra-small superparamagnetic iron oxide (USPIO) MRI in a rat model of whole-and partial-body radiation exposure to measure BM proliferation and vascular damage as surrogates for mapping the amount of body exposed and the anatomic region irradiated.…”