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Developing a Nuclear Global Health Workforce Amid the Increasing Threat of a Nuclear Crisis

  • Frederick M. Burkle (a1) and Cham E. Dallas (a2)


This study argues that any nuclear weapon exchange or major nuclear plant meltdown, in the categories of human systems failure and conflict-based crises, will immediately provoke an unprecedented public health emergency of international concern. Notwithstanding nuclear triage and management plans and technical monitoring standards within the International Atomic Energy Agency and the World Health Organization (WHO), the capacity to rapidly deploy a robust professional workforce with the internal coordination and collaboration capabilities required for large-scale nuclear crises is profoundly lacking. A similar dilemma, evident in the early stages of the Ebola epidemic, was eventually managed by using worldwide infectious disease experts from the Global Outbreak Alert and Response Network and multiple multidisciplinary WHO-supported foreign medical teams. This success has led the WHO to propose the development of a Global Health Workforce. A strategic format is proposed for nuclear preparedness and response that builds and expands on the current model for infectious disease outbreak currently under consideration. This study proposes the inclusion of a nuclear global health workforce under the technical expertise of the International Atomic Energy Agency and WHO’s Radiation Emergency Medical Preparedness and Assistance Network leadership and supported by the International Health Regulations Treaty. Rationales are set forth for the development, structure, and function of a nuclear workforce based on health outcomes research that define the unique health, health systems, and public health challenges of a nuclear crisis. Recent research supports that life-saving opportunities are possible, but only if a rapidly deployed and robust multidisciplinary response component exists. (Disaster Med Public Health Preparedness. 2016;10:129–144)

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Corresponding author

Correspondence and reprint requests to Frederick M. Burkle, Jr, MD, MPH, Harvard Humanitarian Initiative, 14 Story Street, 2nd Floor, Cambridge, MA 02138 (e-mail:


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1. Mackenzie, JS, Drury, P, Arthur, RR, et al. The Global outbreak alert and response network. Glob Public Health. 2014;9(9):1023-1039.
2. Inter-Agency Standing Committee, Global Health Cluster. Concept paper: foreign medical teams. Published May 17, 2011. Accessed June 26, 2011.
3. Burkle, FM. Global health security demands a strong International Health Regulations Treaty and leadership from a highly resourced World Health Organization. Disaster Med Public Health Prep. 2015;9(5):568-580.
4. World Health Organization. Ten things you need to know to implement the IHR. Alert, response, and capacity building under the International Health regulations (IHR). Accessed April 29, 2015.
5. World Health Organization. Executive Board, Special Session on Ebola, Provisional agenda item 9.4, EB136/49, 9 January 2015. Accessed January 15, 2015.
6. Heymann, D. Development of a Plan for a Stronger Global Health Emergency Workforce. Friends of the Resolution, Second meeting, 9 April 2015. Accessed May 4, 2015.
7. Green, WG III, McGinnes, SR. Thoughts on the higher order taxonomy of disasters. Notes on the Science of Extreme Situations, paper no. 7. Updated July 11, 2006. Accessed December 10,2007.
8. Burkle, FM Jr, Greenough, PG. Impact of public health emergencies on modern disaster taxonomy, planning, and response. Disaster Med Public Health Prep. 2008;2(3):192-199.
9. WHO. Effect of Nuclear War on Health and Health Services, 2nd ed. Geneva: World Health Organization; 1987:24-28.
10. National Security Staff Interagency Policy Coordination Subcommittee for Preparedness and Response to Radiological and Nuclear Threats.Planning Guidance for Response to a Nuclear Detonation. 2nd ed. Published June 2010. Accessed October 20, 2015.
11. Burkle, F Jr, Garfield, R. Civilian mortality after the 2003 invasion of Iraq. Lancet. 2013;381(9870):877-879.
12. Burkle, F Jr, Martone, G, Greenough, PG. The Changing face of humanitarian crises. The Brown Journal of World Affairs. Spring/Summer 2014;XX(11):26-42.
13. Kaysen, C, McNamara, RS, Rathjens, GW. Nuclear weapons after the Cold War. Foreign Affairs. Essay, Fall 1991 issue. Accessed April 12, 2015.
14. Arms Control Association. Nuclear weapons: who has what at a glance. Fact Sheets & Briefs. April 2015. Accessed April 4, 2015.
15. Federation of American Scientists. Status of World Nuclear Forces. Accessed April 12, 2015.
16. International Panel on Fissile Materials. Country Perspectives on the Challenges to a Fissile Material (Cutoff) Treaty. Accessed April 4, 2015.
17. Federation of American Scientists. Weapons of Mass Destruction. WMD Around the World. Accessed April 4, 2015.
18. IAEA. Monitoring and Verification in Iran: March 2015. Accessed March 5, 2015.
19. Homeland Security News and Information. Suitcase nukes. Accessed May 1, 2015.
20. Nuclear Safety & Security: ‘Dirty bomb’ threat. IAEA website. Accessed 1,May 2015.
21. Dahl, F. Missing radioactive material may pose ‘dirty bomb’ threat: IAEA. Reuters: World. Published March 21, 2014. Accessed May 1, 2015.
22. Schneider, M, Froggatt, A, Ayukawa, Y, et al. The World Nuclear Industry Status Report 2014. Published August 18, 2014. Accessed April 28, 2015.
23. Rogers, K. Scientist predicts another major earthquake in Japan by 2017. JAPANTODAY. Published August 3, 2014. Accessed April 28, 2015.
24. World Nuclear Association. Nuclear Power in Japan. Updated April 25, 2015. Accessed April 29, 2015.
25. World Economic Forum. Energy Vision 2013: Energy Transitions: Past and Future. Published January 2013. Accessed 19 April 2015.
26. Shermer, M. Will mutual assured destruction continue to deter nuclear war? Scientific American. Published June 1, 2014. Accessed April 14, 2015.
27. Alpha History: Nuclear Weapons. Accessed April 11, 2015.
28. Hamilton, R. Topic Analysis. Nuclear Weapons. Resolved: States ought not possess nuclear weapons. Accessed April 10, 2015.
29. Arms Control Association. The Cuban Missile Crisis. Accessed April 10, 2015.
30. Tannenwald, N. Nuclear weapons and the Vietnam War. The Journal of Strategic Studies. 2006;29(4):675-722. Accessed April 10, 2015.
31. Masco, J. The Nuclear Borderlands: the Manhattan Project in Post-Cold War New Mexico. Chapter 1: The enlightened Earth. Princeton University Press; 2006. Accessed April 12, 2015.
32. Conca, J. The nuclear weapons states: who has them and how many. Forbes. Published September 25, 2014. Accessed April 2015.
33. Sagan, SD. Policy: A call for global nuclear disarmament. Nature. 2012;487:30-32.
34. Burkle, FM Jr. Antisocial personality disorder and pathological narcissism in prolonged conflicts and wars in the 21st century. Disaster Med Public Health Prep. Published online Oct 2015. doi: 10.1017/dmp.2015.113.
35. Singh, VK, Romaine, PL, Seed, TM. Medical countermeasures for radiation exposure and related injuries: characterization of medicines, FDA-approval status and inclusion into the strategic stockpile. Health Phys. 2015;108(6):607-630.
36. Muslim Public Affairs Council. Islamic views regarding terrorism and suicide. Accessed April 9, 2015.
37. Potter, WC, Lewis, J. Cheap and dirty Bombs. Foreign Policy. Published February 17, 2014. Accessed April 9, 2015.
38. Perry, DL. Killing in the name of god: the problem of holy war. Markkula Center for Applied Ethics, Santa Clara University . Accessed April 8, 2015.
39. Hammer, MF, Redd, AJ, Wood, ET, et al. Jewish and Middle Eastern non-jewish populations share a common pool of Y-chromosomes biallelic halotypes. Proc Natl Acad Sci U S A. 200;97(12):6769-6774. Accessed 1 April 2015.
40. Frank, J. Sociopsychological aspects of the nuclear arms race. In: Task Force Report 20: Psychosocial Aspects of Nuclear Developments. Report of the Task Force on Psychosocial Aspects of Nuclear Developments of the American Psychiatric Association. Washington, DC: APA; 1982:1-11.
41. Jenkins, BM. Will Terrorists go Nuclear? The Rand Corporation Series. Published November 1975. Accessed April 15, 2015.
42. Fein, E. The sacred weapons. Bulletin of the Atomic Scientists. August/September 1981:52-53.
43. Dallas, CE, Burkle, FM Jr. Nuclear war in the Middle East: where is the voice of medicine and public health. Prehosp Disaster Med. 2011;26(5):383-385.
44. Flynn, DF, Goans, RE. Nuclear terrorism: triage and medical management of radiation and combined-injury casualties. Surg Clin North Am. 2006;86(3):601-636.
45. Donnelly, EH, Nemhauser, JB, Smith, JM, et al. Acute radiation syndrome: assessment and management. South Med J. 2010;103(6):541-546.
46. Grammaticos, P, Giannoula, F, Fountos, GP. Acute radiation syndrome and chronic radiation syndrome. Hell J Nucl Med. 2013;15(1):56-59.
47. Rea, ME, Gougelet, RM, Nicolaide, RJ, et al. Proposed triage categories for large-scale radiation incidents using high-accuracy biodosimetry methods. Health Phys. 2010;98(2):136-144.
48. Emergency Preparedness and Response: Acute Radiation Syndrome: A Fact Sheet for Clinicians. CDC website. Accessed April 15, 2015.
49. Dallas, CE. Medical lessons learned from Chernobyl relative to nuclear detonations and failed nuclear reactors. Disaster Med Public Health Prep. 2012;6:330-334.
50. Coeytaux, K, Bey, E, Christensen, D, et al. Reported radiation overexposure accidents worldwide, 1980-2013: a systematic review. PLoS One. 2015;10(3):e0118709.
51. McGann, C, Miaullis, A, Page, N. Radiologists: the unsuspecting subject matter experts. J Am Coll Radiol. 2015. Apr 15. pii: S1546-1440(15)00029-0.
52. Health Impacts. Chernobyl Accident Appendix 2. World Nuclear Association website. Updated November 2009. Accessed April 15, 2015.
53. Emergency Preparedness and Response. IAEA Response and Assistance Network. EPR-RANET 2013. website. Published 2013. Accessed April 7, 2015.
54. Whitcomb, RC Jr, Ansari, AJ, Buzzell, JJ, et al. A public health perspective on the U.S. response to the Fukushima radiological emergency. Health Phys. 2015;108(3):357-363.
55. International Campaign to Abolish Nuclear Weapons. No adequate response capacity. ICAN website. response-to-a-nuclear-attack/. Accessed April 1, 2015.
56. Coleman, CN, Sullivan, JM, Bader, JL, et al. Public health and medical preparedness for a nuclear detonation: the nuclear incident medical enterprise. Health Phys. 2015;108(2):149-156.
57. Dallas, CE, Maliha, W, Reeves, G, et al. Nuclear and radiological events. In: Swienton R, Markenson D, eds. Basic Disaster Life Support, Version 3.0. Chicago: American Medical Association; 2012.
58. Barnaby, S, Rotblat, J. Nuclear war: the aftermath: the effects of nuclear war. Ambio. 1982;11:84-94.
59. Dallas, CE, Bell, WC. Effects of a 10-kt IND detonation on human health and the area health care system: effects on the area health care system. In: Assessing Medical Preparedness to Respond to a Terrorist Nuclear Event. Washington, DC: The National Academies Press; 2009:20-26.
60. Waselenko, JK. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Ann Intern Med. 2004;140:1037-1051.
61. Dallas, CE, Bell, WC. Prediction modeling to determine medical response to urban attack. Disaster Med Public Health Prep. 2007;1(2):80-89.
62. Postol, TA. Possible fatalities from superfires following nuclear attacks in or near urban areas . In: Soloman F, Marston RQ, eds. The Medical Implications of Nuclear War. Washington, DC: National Academy Press; 1986:15.
63. Gonzalez, AJ. Radiation protection in the aftermath of a terrorist attack involving exposure to ionizing radiation. Health Physics Society. 2005;89(5):418-446.
64. Dallas, CE, Bell, W, Stewart, D, et al. Nuclear war between Israel and Iran: lethality beyond the pale. Conflict and Health. 2013;7(1):10.
65. Daugherty, W, Levi, B, von Hippel, F. Casualties due to blast, heat and radioactive fallout from various hypothetical nuclear attacks on the US. In: The Medical Implications of Nuclear War. Washington, DC: National Academy Press; 1986.
66. Facts and Details. Evacuation of the Fukushima area. Accessed April 13, 2015.
67. McCurry, J. Fukushima nuclear disaster: three years on 120,00 evacuees remain uprooted. The Guardian. Published September 10, 2014. Accessed April 13, 2015.
68. Fukushima on the Globe. Evacuation orders and restricted areas. Accessed April 13, 2015.
69. Wilson, R. Evacuation criteria after a nuclear accident: a personal perspective. Dose Response. 2012;10(4):480-499.
70. Dallas, CE. Impact of small nuclear weapons on Washington DC: outcomes and emergency response recommendations. Testimony: US Senate Hearing for the Committee on Homeland Security and Governmental Affairs, April 15, 2008.,d.cGU. Accessed May 6, 2015.
71. Wood, A, Apthorpe, R, Borton, J. Evaluating International Humanitarian Action. London: Zed Books; 2001.
72. Burkle, FM Jr, Redmond, AD, McArdle, DF. An authority for crisis coordination and accountability. Lancet. 2012;379(9833):2223-2225.
73. Abrams, HL, Von Kaenel, WE. Medical survivors of nuclear war: infection and the spread of communicable disease. N Engl J Med. 1981;305:1226-1232.
74. DiCarlo, AL, Maher, C, Hick, JL, et al. Radiation injury after a nuclear detonation: medical consequences and the need for scarce resources allocation. Disaster Med Public Health Prep. 2011;5(suppl 1):S32-S44.
75. Coleman, CN, Knebel, AR, Hick, JL, et al. Scarce resources for nuclear detonation: project overview and challenges. Disaster Med Public Health Prep. 2011;5(suppl 1):S13-S19.
76. Knebel, AR, Coleman, CN, Cliffer, KD, et al. Allocation of scarce resources after a nuclear detonation: setting the context. Disaster Med Public Health Prep. 2011;5(suppl 1):S20-S31.
77. Coleman, CN, Weinstock, DM, Casagrande, R, et al. Triage and treatment tools for use in a scarce resources-crisis standards of care setting after a nuclear detonation. Disaster Med Public Health Prep. 2011;5(suppl 1):S111-S121.
78. Armed Forces Radiobiology Research Institute Workshop. GI Reeves, DG Jarrett, et al, eds. Triage of Irradiated Personnel. Proceedings; September 25-27, 1996; Bethesda, MD. Accessed May 4, 2015.
79. Flynn, DF, Goans, RE. Nuclear terrorism: triage and medical treatment of radiation and combined-injury casualties. Surg Clin North Am. 2006;86(3):601-636.
80. Kumar, P, Jagetia, GC. A review of triage and management of burn victims following a nuclear disaster. Burns. 1994;20(5):397-402.
81. Bland, SA. Masscasualty management for radiological and nuclear incidents. J R Army Med Corps. 2004;159(3 Suppl 1):27-34.
82. Hick, JL, Weinstock, DM, Coleman, CN, et al. Health care system planning for and response to a nuclear detonation. Disaster Med Public Health Prep. 2011;5(suppl 1):S73-S88.
83. Coleman, CN, Hrdina, C, Bader, JL, et al. Medical response to a radiologic/nuclear event: integrated plan from the Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services. Ann Emerg Med. 2008;53(2):213-222.
84. Blumenthal, DJ, Bader, JL, Christensen, D, et al. A sustainable training strategy for improving health care following a catastrophic radiological or nuclear incident. Prehosp Disaster Med. 2014;29(1):80-86.
85. Hrdina, CM, Coleman, CN, Bogucki, S, et al. The “RTR” medical response system for nuclear and radiological mass-casualty incidents: a functional Triage-Treatment-Transport medical response model. Prehosp Disaster Med. 2009;24(3):167-178.
86. Ossetrova, NI, Sandgren, DJ, Blakely, WF. Protein biomarkers for enhancement of radiation dose and injury assessment in nonhuman primate total-body irradiation model. Radiat Prot Dosimetry. 2014;159(1-4):61-76.
87. Deperas-Kaminska, M, Bajinskis, A, Marczyk, M, et al. Radiation-induced changes in levels of selected proteins in peripheral blood serum of breast cancer patients as a potential triage biodosimeter for large-scale radiological emergencies. Health Phys. 2014;107(6):555-563.


Developing a Nuclear Global Health Workforce Amid the Increasing Threat of a Nuclear Crisis

  • Frederick M. Burkle (a1) and Cham E. Dallas (a2)


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