Public Health Risks in Radiological Emergencies

1. Public Health RisksinRadiological Emergencies Public Health and Healthcare Issues

2. Public Health and Healthcare

3. Mass Casualty Events • Produce large number of patients quickly • Surge of patients with severe and minor injuries can rapidly stress the healthcare system and first receivers • The majority of injured self report to healthcare facilities • Injured report to the closest hospitals to the event

4. Radiation Mass Surge Event • Radiation further complicates response and adds additional stress to a stressful situation • Radiation raises the fear of contamination in staff who have little understanding of radiation • Radiation increases the number of worried well wanting medical evaluation and monitoring

5. Perspective on Mass Surge • It is estimated that 10% of the total population will want to be screened for radioactivity exposure • Psychological trauma is the driving force

6. Fukushima, Japan 2011 • 200,000 of a population of 2 million people were scanned and evaluated for contamination • Fear of contamination • Fear of health consequences

7. Goiania, Brazil 1987 • 249 people found significantly contaminated • 112,000 were evaluated and screened

8. Tokyo Sarin Attack • Saint Luke’s International Hospital • 27% of staff contaminated • 526 victims • Over 5000 evaluated • Majority psychological

10. CDC Guiding Principles • First priority is to save lives and treat the injured first • Contamination with radioactive materials is not immediately-life treating • Initial population monitoring activities should focus on preventing acute radiation health effects • Scalability and flexibility are an important part of the planning process

11. CDC Guiding Principles Continued • Fear of radiation is high, higher than with other agents of terrorism • Radiological decontamination differs from those for chemical agents • Law enforcement agencies will be involved in response to a radiological terrorism event

12. Roles and Responsibilities of Public Health • CDC lists 15 responsibilities for federal, state and local Public Health • “As a general rule, during the initial stages of the incident local and state officials should be prepared to handle the crisis without federal assistance” (CDC PopulationmonitoringinRadiationEmergencies)

13. Roles and Responsibilities • Protecting the public’s health • Monitoring workers health and safety • Ensuring safe shelters for the population Ensuring the safety of food and water • Coordinating sampling and laboratory analysis of bio and environmental samples • Conducting field investigations • Monitoring people who may have been contaminated with radioactive materials or exposed to radiation • Conducting or assisting in decontamination • Recommending management protocols for affected populations or individuals

14. Hospital Mass Surge Issues • Patients arrive before the event is recognized as radiological by first responders • Contamination of the ER occurs before the event is recognized as radiological • Staff ill prepared to deal with radiological effected patients • Correct staff not present • Surge of worried well stresses facility’s ability to care for the seriously injured

15. Hospital Mass Surge Issues • Hospital staff lack the ability to communicate with the massive crowds of people • Staff fearful of radiation and the large crowds seeking care • Limited decon capabilities and limited ability to scan patients for radiation • Traffic management issues, abandoned cars, contaminated cars

16. The Role of Community Reception Centers • To divert people with minor or no injuries away from the hospital for scanning and counseling • To decrease the impact of surge on patient care and hospital staff • To identify people who may need immediate assistance----decontamination, medical attention, psychosocial needs

17. Objectives of Monitoring • Identify individuals whose health is in immediate danger • Identify people who may need medical treatment for contamination or exposure • To try to minimize future health for long term health monitoring • Register potentially affected populations for long term health monitoring

18. Security Needs • Traffic management at hospitals and Reception Centers • Security of facilities inside and on grounds • Risk of facility contamination • Threatening environment to staff responding to the incident • Risk as a secondary target

19. Why Security for Hospitals • Represent critical infrastructure in their community • Symbols of safety and security for a community being affected by a mass casualty event • To ensure safety of staff while providing care to the surge of patients • To facilitate traffic flow, campus lock down, facility lock down

20. Why Reception Center Security • Traffic management • Crowd containment and management • Safety of staff and patients • Secondary target • Limit access to the facility and grounds • Security of personal belongings

21. Planning and Communication