Singapore is considered a prime target for transnational terrorism. Perpetrators may select an explosive radiation dispersal device or “dirty bomb” as their weapon of choice. Additional risks of a local radiological emergency may arise from mishaps involving visiting marine nuclear-powered vessels. Strategies and methods used to enhance preparedness to respond to radiological mass-casualty incidents (MCIs) will be described.

A core group comprising hospital emergency managers and radiology and emergency department staff spearheaded preparedness efforts. The Ministry of Health Guiding Document on managing radiological MCIs provides the principles and operational concepts to anchor the development of local protocols. Discussion sessions, site visits, drills, and exercises are conducted to improve organization performance. Expert opinion and feedback from various stakeholders and partners help shaped the overall plan.

Preparedness activities focused on improving surge response capability through broad categories include: 1. Staff—Radiation response teams were developed and assigned roles and responsibilities. Training and education programs were created for different staff positions, e.g., on correct usage of electronic personal dosimeters and acute radiation syndrome. 2. Stuff—Material resources such as antidotes, and expendables like floor covering were procured and stored. 3. System—These areas include: (a) activation procedures; (b) communication plans; (c) safety measures; (d) casualty transfer protocols; and (e) handling radiologically contaminated waste and materials. 4. Space—Potential care areas, such as radiation isolation rooms were designated. An algorithm was devised to guide casualty management.

Facility preparedness for radiological MCIs requires multidisciplinary involvement and the creation of trusting partnerships. More research is needed to identify the metrics to measure success objectively and aid protocol revisions.