Skip to main content Accessibility help
×
Home

A Sustainable Training Strategy for Improving Health Care Following a Catastrophic Radiological or Nuclear Incident

  • Daniel J. Blumenthal (a1), Judith L. Bader (a2), Doran Christensen (a3), John Koerner (a4), John Cuellar (a5), Sidney Hinds (a6), John Crapo (a7), Erik Glassman (a7), A. Bradley Potter (a7) and Lynda Singletary (a7)...

Abstract

The detonation of a nuclear device in a US city would be catastrophic. Enormous loss of life and injuries would characterize an incident with profound human, political, social, and economic implications. Nevertheless, most responders have not received sufficient training about ionizing radiation, principles of radiation safety, or managing, diagnosing, and treating radiation-related injuries and illnesses. Members throughout the health care delivery system, including medical first responders, hospital first receivers, and health care institution support personnel such as janitors, hospital administrators, and security personnel, lack radiation-related training. This lack of knowledge can lead to failure of these groups to respond appropriately after a nuclear detonation or other major radiation incident and limit the effectiveness of the medical response and recovery effort. Efficacy of the response can be improved by getting each group the information it needs to do its job. This paper proposes a sustainable training strategy for spreading curricula throughout the necessary communities. It classifies the members of the health care delivery system into four tiers and identifies tasks for each tier and the radiation-relevant knowledge needed to perform these tasks. By providing education through additional modules to existing training structures, connecting radioactive contamination control to daily professional practices, and augmenting these systems with just-in-time training, the strategy creates a sustainable mechanism for giving members of the health care community improved ability to respond during a radiological or nuclear crisis, reducing fatalities, mitigating injuries, and improving the resiliency of the community.

Blumethal D , Bader J , Christensen D , Koerner J , Cuellar J , Hinds S , Crapo J , Glassman ES , Potter AB , Singletary L . A Sustainable Training Strategy for Improving Health Care Following a Catastrophic Radiological or Nuclear Incident. Prehosp Disaster Med. 2014;29(1):80-86 .

Copyright

Corresponding author

Correspondence: Daniel Blumenthal, PhD 1000 Independence Avenue SW Washington, DC 20585 USA c/o Dr. Daniel Blumenthal, NA-42 E-mail Daniel.Blumenthal@nnsa.doe.gov

References

Hide All
1. Interagency Policy Coordination Subcommittee for Preparedness and Response to Radiological and Nuclear Threats. Planning Guidance for the Response to a Nuclear Detonation. http://www.epa.gov/rpdweb00/docs/er/planning-guidance-for-response-to-nuclear-detonation-2-edition-final.pdf. Published 2010. Accessed September 5, 2012.
2. Becker, SM. Emergency Communication and Information Issues in Terrorist Events Involving Radioactive Materials. Biosecur Bioterror. 2004;2(3):195-207.
3. 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;Suppl 1:S111-121.
4. Council of State and Territorial Epidemiologists. The Status of State Level Radiation Emergency Preparedness and Response Capabilities. 2010. http://www.radiationready.org/wp/wp-content/uploads/2012/05/2010raditionreport.pdf. Published 2010. Accessed October 22, 2012.
5. Sheikh, S, McCormick, LC, Pevear, J, et al. Radiological preparedness-awareness and attitudes: a cross-sectional survey of emergency medicine residents and physicians at three academic institutions in the United States. Clin Toxicol (Phila). 2012;50(1):34-38.
6. Veenema, TG, Walden, B, Feinstein, N, Williams, JP. Factors affecting hospital-based nurses’ willingness to respond to a radiation emergency. Disaster Med Public Health Prep. 2008;2(4):224-229.
7. Vano, E, Ohno, K, Cousins, C, et al. Radiation risks and radiation protection training for health care professionals: ICRP and the Fukushima experience. J Radiol Prot. 2011;31:285-287.
8. Gonzalez, AJ, Akashi, M, Boice, JD Jr., et al. Radiological protection issues arising during and after the Fukushima nuclear reactor accident. J Radiol Prot. 2013;33:497-571.
9. U.S. Department of Health and Human Services. National Health Security Strategy of the United States of America. http://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhss-final.pdf. Published 2009. Accessed October 4, 2012.
10. Benjamin, GC, McGeary, M, McCutchen, SR, eds. Assessing Medical Preparedness to Respond to a Terrorist Nuclear Event: Workshop Report. Washington, D.C.: The National Academies Press. 2009.
11. Sheikh, S, McCormick, LC, Pevear, J, et al. Radiological preparedness-awareness and attitudes: a cross-sectional survey of emergency medicine residents and physicians at three academic institutions in the United States. Clin Toxicol (Phila). 2012;50(1):34-38.
12. Radiation Emergency Medical Management Web site. http://www.remm.nlm.gov. Accessed May 15, 2013.
13. Nuclear Detonation Response Communications Working Group. Nuclear Detonation Preparedness – Communicating in the Immediate Aftermath. http://www.remm.nlm.gov/NuclearDetonationPreparedness.pdf. Published 2010. Accessed April 30, 2012.
14. Becker, SM, Middleton, SA. Improving Hospital Preparedness for Radiological Terrorism: Perspectives from Emergency Department Physicians and Nurses. Disaster Med Public Health Prep. 2008;2(3):174-184.
15. Becker, SM. Emergency Communication and Information Issues in Terrorist Events Involving Radioactive Materials. Biosecur Bioterror. 2004;2(3):195-207.
16. Veenema, TG, Walden, B, Feinstein, N, Williams, JP. Factors affecting hospital-based nurses’ willingness to respond to a radiation emergency. Disaster Med Public Health Prep. 2008;2(4):224-229.
17. Sheikh, S, McCormick, LC, Pevear, J, et al. Radiological preparedness-awareness and attitudes: a cross-sectional survey of emergency medicine residents and physicians at three academic institutions in the United States. Clin Toxicol (Phila). 2012;50(1):34-38.
18. Curran, VR, Keegan, D, Parsons, W, et al. A comparative analysis of the perceived continuing medical education needs of a cohort of rural and urban Canadian family physicians. Can J Rural Med. 2007;12(3):161-166.
19. Thompson, MJ, Skillman, SM, Johnson, K, et al. Assessing physicians’ continuing medical education (CME) needs in the U.S.-associated Pacific jurisdictions. Pac Health Dialog. 2002;9(1):11-16.
20. Becker, SM, Middleton, SA. Improving Hospital Preparedness for Radiological Terrorism: perspectives from emergency department physicians and nurses. Disaster Med Public Health Prep. 2008;2(3):174-184.
21. Akashi, M, Kumagaya, K, Kondo, H, Hirose, Y. Concerns of Disaster Medical Assistance Team (DMAT) members about troubles at the nuclear power plant: experience from the Niigata Chuetsu-Oki earthquake, 16 July 2007, in Japan. Health Phys. 2010;98(6):804-809.
22. Cone, DC, Cummings, BA. Hospital disaster staffing: if you call, will they come? Am J Disaster Med. 2006;1(1):28-36.
23. Hendee, WR. Public Perception of Radiation Risks. In: Young JP, Yalow RS, eds, Radiation and Public Perception. Washington, DC, USA: American Chemical Society. 1995:13-22.
24. Veenema, TG, Walden, B, Feinstein, N, Williams, JP. Factors affecting hospital-based nurses’ willingness to respond to a radiation emergency. Disaster Med Public Health Prep. 2008;2(4):224-229.
25. Kaiser, HE, Barnett, DJ, Hsu, EB, et al. Perspectives of future physicians on disaster medicine and public health preparedness: challenges of building a capable and sustainable auxiliary medical workforce. Disaster Med Public Health Prep. 2009;3(4):210-216.
26. Smith, J, Levy, MJ, Hsu, EB, Lee, LJ. Disaster curricula in medical education: pilot survey. Prehosp Disaster Med. 2012;27(5):492-494.
27. Parrish, AR, Oliver, S, Jenkins, D, et al. A short medical school course on responding to bioterrorism and other disasters. Acad Med. 2005;80(9):820-823.
28. Markenson, D, DiMaggio, C, Redlener, I. Preparing health professions students for terrorism, disaster, and public health emergencies: core competencies. Acad Med. 2005;80(6):517-526.
29. Walsh, L, Subbarao, I, Gebbie, K, et al. Core competencies for disaster medicine and public health. Disaster Med Public Health Prep. 2012;6(1):44-52.
30. Curran, VR, Keegan, D, Parsons, W, et al. A comparative analysis of the perceived continuing medical education needs of a cohort of rural and urban Canadian family physicians. Can J Rural Med. 2007;12(3):161-166.
31. Thompson, MJ, Skillman, SM, Johnson, K, et al. Assessing physicians’ continuing medical education (CME) needs in the U.S.-associated Pacific jurisdictions. Pac Health Dialog. 2002;9(1):11-16.
32. Hendee, WR. Public Perception of Radiation Risks. In: Young JP, Yalow RS, eds, Radiation and Public Perception. Washington, DC, USA: American Chemical Society. 1995:13-22.
33. 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;Suppl 1:S111-121.
34. Rosenstein, BS, Held, KD, Rockwell, S, et al. American Society for Radiation Oncology (ASTRO) survey of radiation biology educators in U.S. and Canadian radiation oncology residency programs. Int J Radiat Oncol Biol Phys. 2009;75(3):896-905.
35. Health Physics Society. Human Capital Crisis Task Force Report. http://hps.org/documents/ManpowerTaskForceReport.pdf. Published 2004. Accessed May 15, 2013.
36. ORISE report shows number of health physics Ph.D.s declined in 2009. Oak Ridge Institute for Science and Education Web site. http://orise.orau.gov/media-center/news-releases/2010/fy10-37-orise-report-shows-decline-health-physics-doctorates.aspx. Accessed May 15, 2013.
37. Burwick, RM, Schulkin, J, Cooley, SW, et al. Recent trends in continuing medical education among obstetrician-gynecologists. Obstet Gynecol. 2011;117(5):1060-1064.
38. American Board of Medical Specialties Web site. http://www.abms.org. Accessed November 5, 2012.
39. Sheikh, S, McCormick, LC, Pevear, J, et al. Radiological preparedness-awareness and attitudes: a cross-sectional survey of emergency medicine residents and physicians at three academic institutions in the United States. Clin Toxicol (Phila). 2012;50(1):34-38.
40. Veenema, TG, Walden, B, Feinstein, N, Williams, JP. Factors affecting hospital-based nurses’ willingness to respond to a radiation emergency. Disaster Med Public Health Prep. 2008;2(4):224-229.
41. Becker, SM, Middleton, SA. Improving Hospital Preparedness for Radiological Terrorism: perspectives from emergency department physicians and nurses. Disaster Med Public Health Prep. 2008;2(3):174-184.
42. Homeland Security Presidential Directive 21. The George W. Bush White House Web site. http://georgewbushwhitehouse.archives.gov/news/releases/2007/10/20071018-10.html. Accessed May 15, 2013.
43. Federal Emergency Management Agency. Nuclear/Radiation Incident Annex. http://www.fema.gov/pdf/emergency/nrf/nrf_nuclearradiologicalincidentannex.pdf. Accessed May 13, 2013.
44. Planners, Preparedness, and Response. Radiation Emergency Medical Management Web site. http://www.remm.nlm.gov/remm_Preplanning.htm#stateslocal. Accessed April 30, 2013.
45. Interagency Policy Coordination Subcommittee for Preparedness and Response to Radiological and Nuclear Threats. Planning Guidance for the Response to a Nuclear Detonation. http://www.epa.gov/rpdweb00/docs/er/planning-guidance-for-response-to-nuclear-detonation-2-edition-final.pdf. Published 2010. Accessed September 5, 2012.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed