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

Published online by Cambridge University Press:  12 February 2014

Daniel J. Blumenthal*
Affiliation:
US Department of Energy, National Nuclear Security Administration, Washington DCUSA
Judith L. Bader
Affiliation:
US Department of Health and Human Services, Washington DCUSA
Doran Christensen
Affiliation:
Radiation Emergency Assistance Center/Training Site, Oak Ridge, TennesseeUSA
John Koerner
Affiliation:
US Department of Health and Human Services, Washington DCUSA
John Cuellar
Affiliation:
Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
Sidney Hinds
Affiliation:
Armed Forces Radiobiology Research Institute, Bethesda, MarylandUSA
John Crapo
Affiliation:
Oak Ridge Associated Universities, Oak Ridge Institute for Science and Education, Arlington, VirginiaUSA
Erik Glassman
Affiliation:
Oak Ridge Associated Universities, Oak Ridge Institute for Science and Education, Arlington, VirginiaUSA
A. Bradley Potter
Affiliation:
Oak Ridge Associated Universities, Oak Ridge Institute for Science and Education, Arlington, VirginiaUSA
Lynda Singletary
Affiliation:
Oak Ridge Associated Universities, Oak Ridge Institute for Science and Education, Arlington, VirginiaUSA
*
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

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.

BlumethalD, BaderJ, ChristensenD, KoernerJ, CuellarJ, HindsS, CrapoJ, GlassmanES, PotterAB, SingletaryL. A Sustainable Training Strategy for Improving Health Care Following a Catastrophic Radiological or Nuclear Incident. Prehosp Disaster Med. 2014;29(1):80-86.

Type
Special Report
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

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References

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.Google Scholar
2. Becker, SM. Emergency Communication and Information Issues in Terrorist Events Involving Radioactive Materials. Biosecur Bioterror. 2004;2(3):195-207.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
12. Radiation Emergency Medical Management Web site. http://www.remm.nlm.gov. Accessed May 15, 2013.Google Scholar
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.Google Scholar
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.Google Scholar
15. Becker, SM. Emergency Communication and Information Issues in Terrorist Events Involving Radioactive Materials. Biosecur Bioterror. 2004;2(3):195-207.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
22. Cone, DC, Cummings, BA. Hospital disaster staffing: if you call, will they come? Am J Disaster Med. 2006;1(1):28-36.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
26. Smith, J, Levy, MJ, Hsu, EB, Lee, LJ. Disaster curricula in medical education: pilot survey. Prehosp Disaster Med. 2012;27(5):492-494.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
35. Health Physics Society. Human Capital Crisis Task Force Report. http://hps.org/documents/ManpowerTaskForceReport.pdf. Published 2004. Accessed May 15, 2013.Google Scholar
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.Google Scholar
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.Google Scholar
38. American Board of Medical Specialties Web site. http://www.abms.org. Accessed November 5, 2012.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.Google Scholar
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.Google Scholar
43. Federal Emergency Management Agency. Nuclear/Radiation Incident Annex. http://www.fema.gov/pdf/emergency/nrf/nrf_nuclearradiologicalincidentannex.pdf. Accessed May 13, 2013.Google Scholar
44. Planners, Preparedness, and Response. Radiation Emergency Medical Management Web site. http://www.remm.nlm.gov/remm_Preplanning.htm#stateslocal. Accessed April 30, 2013.Google Scholar
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.Google Scholar