Nationwide Response Issues
After an Improvised
Nuclear Device Attack
Medical and Public Health Considerations
for Neighboring Jurisdictions
Workshop Summary
Forum on Medical and Public Health Preparedness for
Catastrophic Events
Board on Health Sciences Policy
Miriam Davis, Megan Reeve, and Bruce M. Altevogt, Rapporteurs
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This activity was supported by contracts between the National Academy of Sciences and the American College of Emergency Physicians; American Hospital Association; American Medical Association; Association of State and Territorial Health Officials; Centers for Disease Control and Prevention (Contract No. 200-2011-38807, TO #3); Department of Defense (Contract No. HT0011-11-P-0186); Department of Defense, Uniformed Services University of the Health Sciences (Contract No. HT9404-12-1-0022); Department of Health and Human Services’ National Institutes of Health: National Institute of Allergy and Infectious Diseases, National Institute of Environmental Sciences, National Library of Medicine (Contract No. HHSN26300007 [Under Base 1 #HHSN263201200074I]); Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (Contract No. HHSO100201000021P); Department of Homeland Security’s Federal Emergency Management Agency (Contract No. HSFE20-12-P-0165); Department of Homeland Security, Office of Health Affairs (Contract No. HSHQDC-11-J-002336 [Master Contract # 10000439]); Department of Transportation’s National Highway Traffic Safety Administration (Contract No. DTNH22-10-H-00287); Department of Veterans Affairs (Contract No. 101-G09041); Emergency Nurses Association; Food and Drug Administration (Contract No. HHSF22301027T [Under Base Contract DHHS-8598]); Infectious Disease Society of America; Martin, Blanck & Associates; Mayo Clinic; Merck Sharp & Dohme Corp. (Contract No. 2391); National Association of Chain Drug Stores; National Association of County and City Health Officials; National Association of Emergency Medical Technicians; Pharmaceutical Research and Manufactures of America; Target Corporation; Trauma Center Association of America; and United Health Foundation. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity.
International Standard Book Number-13: 978-0-309-28601-5
International Standard Book Number-10: 0-309-28601-8
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Cover Images: Left: Augustino, Jocelyn. Aerial of local residents making their way home days after Hurricane Ike (2008). Federal Emergency Management Agency Photo Library, http://www.fema.gov/photolibrary/photo_details.do?id=38812. Right: Buddemeier, Brooke. “Medical and public health considerations in the aftermath of nuclear terrorism.” Presentation at the Institute of Medicine workshop Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions, Washington, DC, January 23-24, 2013.
Suggested citation: IOM (Institute of Medicine). 2014. Nationwide response issues after an improvised nuclear device attack: Medical and public health considerations for neighboring jurisdictions: Workshop summary. Washington, DC: The National Academies Press.
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”—Goethe
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.
NATIONWIDE RESPONSE ISSUES AFTER AN IMPROVISED NUCLEAR DEVICE ATTACK WORKSHOP PLANNING COMMITTEE1
JACK HERRMANN (Co-Chair), National Association of County and City Health Officials, Washington, DC
JOHN L. HICK (Co-Chair), Hennepin County Medical Center, Minneapolis, MN
GEORGES C. BENJAMIN, American Public Health Association, Washington, DC
JAMES S. BLUMENSTOCK, Association of State and Territorial Officials, Arlington, VA
JOHN CUELLAR, Office of Health Affairs, Department of Homeland Security, Washington, DC
LISA E. GORDON-HAGGERTY, President, LEG, Inc., McLean, VA
JAMES R. KISH, Federal Emergency Management Agency, Department of Homeland Security, Washington, DC
CHRISTINE KOSMOS, Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, GA
GRAYDON LORD, Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
DAVID E. MARCOZZI, Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
SUZET M. MCKINNEY, Chicago Department of Health, IL
CHARLES MILLER, Radiation Studies Branch, Centers for Disease Control and Prevention, Atlanta, GA
IRWIN REDLENER, National Center for Disaster Preparedness; Mailman School of Public Health, Columbia University, New York, NY
RICHARD REED, American Red Cross, Washington, DC
MITCH STRIPLING, New York City Department of Health and Mental Hygiene, NY
ERIC S. TONER, UPMC Center for Health Security, Baltimore, MD
JODY R. WIREMAN, Force Health Protection Division, U.S. Northern Command, Peterson Air Force Base, CO
___________________
1Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
FORUM ON MEDICAL AND PUBLIC HEALTH PREPAREDNESS FOR CATASTROPHIC EVENTS1
ROBERT P. KADLEC (Co-Chair), RPK Consulting, LLC, Alexandria, VA
LYNNE R. KIDDER (Co-Chair), The Bipartisan WMD Terrorism Research Center, Washington, DC
ALEX J. ADAMS, National Association of Chain Drug Stores, Alexandria, VA
ROY L. ALSON, American College of Emergency Physicians, Winston-Salem, NC
GEORGES C. BENJAMIN, American Public Health Association, Washington, DC
CAPT. D. W. CHEN, Office of the Assistant Secretary of Defense for Health Affairs, Department of Defense, Washington, DC
BROOKE COURTNEY, Office of Counterterrorism and Emerging Threats, Food and Drug Administration, Washington, DC
JEFFREY S. DUCHIN, Public Health–Seattle & King County and University of Washington
BRUCE EVANS, National Association of Emergency Medical Technicians, Upper Pine River Fire Protection District, Bayfield, CO
ALEXANDER G. GARZA, Office of Health Affairs, Department of Homeland Security, Washington, DC
JULIE L. GERBERDING, Merck Vaccines, Merck & Co., Inc., West Point, PA
LEWIS R. GOLDFRANK, New York University School of Medicine, New York
DAN HANFLING, INOVA Health System, Falls Church, VA
JACK HERRMANN, National Association of County and City Health Officials, Washington, DC
JAMES J. JAMES, American Medical Association, Chicago, IL
PAUL E. JARRIS, Association of State and Territorial Health Officials, Arlington, VA
BRIAN KAMOIE, The White House, Washington, DC
LISA G. KAPLOWITZ, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
___________________
1Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
ALI S. KHAN, Centers for Disease Control and Prevention, Atlanta, GA
MICHAEL G. KURILLA, National Institute of Allergy and Infectious Diseases, Washington, DC
JAYNE LUX, National Business Group on Health, Washington, DC
NICOLE MCKOIN, Target Corporation, Minneapolis, MN
MARGARET M. MCMAHON, Emergency Nurses Association, Williamstown, NJ
AUBREY K. MILLER, National Institute of Environmental Health Sciences, Bethesda, MD
MATTHEW MINSON, Texas A&M University, College Station
ERIN MULLEN, Pharmaceutical Research and Manufacturers of America, Washington, DC
JOHN OSBORN, Mayo Clinic, Rochester, MN
ANDREW T. PAVIA, Infectious Diseases Society of America, Salt Lake City, UT
STEVEN J. PHILLIPS, National Library of Medicine, Bethesda, MD
LEWIS J. RADONOVICH, Department of Veterans Affairs, Washington, DC
KENNETH SCHOR, Uniformed Services University of the Health Sciences, Bethesda, MD
ROSLYNE SCHULMAN, American Hospital Association, Washington, DC
RICHARD SERINO, Federal Emergency Management Agency, Department of Homeland Security, Washington, DC
SHARON A. R. STANLEY, American Red Cross, Circleville, OH
ERIC S. TONER, UPMC Center for Health Security, Baltimore, MD
REED V. TUCKSON, UnitedHealth Group, Minneapolis, MN
MARGARET VANAMRINGE, The Joint Commission, Washington, DC
CRAIG VANDERWAGEN, Martin, Blanck & Associates, Alexandria, VA
JENNIFER WARD, Trauma Center Association of America, Las Cruces, NM
GAMUNU WIJETUNGE, National Highway Traffic Safety Administration, Washington, DC
Reviewers
This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:
Timothy Cooper, Delaware Division of Public Health
Steven Englender, City of Cincinnati Department of Health
Onora Lien, Northwest Healthcare Response Network
Ruth McBurney, Conference of Radiation Control Program Directors
Monica Schoch-Spana, UPMC Center for Health Security
Tammy Taylor, Los Alamos National Laboratories
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Hellen Gelband, Center for Disease Dynamics, Economics and Policy. Appointed by the Institute of Medicine, she was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Re-
Contents
2 PUBLIC HEALTH AND LOGISTICAL CONSIDERATIONS
Public Health Impact on Outlying Communities
3 FEDERAL PROGRAMS AND PERSPECTIVES
Office of the Assistant Secretary for Preparedness and Response
Centers for Disease Control and Prevention
Federal Emergency Management Agency
U.S. Northern Command and Other Military Forces
4 LOCAL, STATE, AND REGIONAL PERSPECTIVES AND PROGRAMS
Planning for an IND Attack: A Case Study
Efforts in a Large Metropolitan Region
Efforts in an Outlying Community
5 CHALLENGES TO COMMAND AND CONTROL
Establishing Functions After an IND Attack
Perspective from the Office of the Assistant Secretary for Preparedness and Response
6 RISK COMMUNICATION AND EDUCATION
Lessons from Nuclear Reactor Accidents
Risk Communication Efforts at FEMA
The Role of Public Information Officers
7 MONITORING AND MASS CARE IN OUTLYING COMMUNITIES
The Need for Reception Centers and Population Monitoring
Building Capacity for Community Reception Centers
Family Assistance in Outlying Communities
National Networks to Assist in Victim Transport and Care
8 REORIENTING AND AUGMENTING PROFESSIONAL APPROACHES
Mental Health Implications of an IND
Health and Safety of Emergency Responders
9 ROLES OF REGIONAL HEALTH CARE COALITIONS IN PLANNING AND RESPONSE
Improving Hospital Preparedness
National Capital Region Health Care Coalitions
Roles for Outlying Communities
