Screening Travelers for Radiological Contamination

1. Screening Travelers for Radiological Contamination Perspective from the National Alliance for Radiation Readiness

2. Outline Disclaimer: Information contained in this document does not constitute advice and does not represent the views of CDC or the U.S. Department of Health and Human Services. Use of any provision herein should be considered only in conjunction with advice from legal counsel. Provisions may need to be modified, supplemented, or replaced to ensure appropriate citation to, or compliance with, relevant laws or to otherwise address the needs or requirements of a specific jurisdiction. Overview of the NARR Travelers Screening - 2011 NARR Tabletop Exercise Travelers Screening - 2014

3. National Alliance for Radiation Readiness (NARR) • A coalition of organizations committed to improving the nation’s ability to prepare, respond, and recover from radiological emergencies at the local, state, and national levels • 15 Member Agencies • 10 Federal Partners • Administered by the ASTHO through a cooperative agreement with the CDC , National Center for Environmental Health, Radiation Studies Branch

4. NARR Membership • International Association of Emergency Managers (IAEM) • National Association of County and City Health Officials (NACCHO) • National Association of State EMS Officials (NASEMSO) • National Disaster Life Support Foundation (NDSLF) • National Emergency Management Association (NEMA) • National Public Health Information Coalition (NPHIC) • Society for Disaster Medicine and Public Health (SDMPH) American Association of Poison Control Centers (AAPCC) American Hospital Association (AHA) Association of Public Health Laboratories (APHL) Association of Schools of Public Health (ASPH) Association of State and Territorial Health Officials (ASTHO) Conference of Radiation Control Program Directors (CRCPD) Council of State and Territorial Epidemiologists (CSTE) Health Physics Society (HPS)

5. Federal Partner Agencies Centers for Disease Control and Prevention (CDC) Office of the Assistant Secretary for Preparedness and Response/US Department of Health and Human Services (ASPR/HHS) US Department of Homeland Security (DHS) Environmental Protection Agency (EPA) US Department of Energy (DOE) US Department of Agriculture (USDA) Food and Drug Administration (FDA) US Nuclear Regulatory Commission (NRC) Federal Emergency Management Agency (FEMA)

6. NARR Purpose • To serve as the collective “voice of health” in radiological preparedness through the: • Participation in national dialogues on radiological emergency issues • Provision feedback on documents, policies, and guidelines • Convening of partners to raise awareness of and resolve radiological emergency issues • To build radiological emergency preparedness, response and recovery capacity and capabilities

7. NARR Clearinghouse www.radiationready.org Forum for sharing resources, tools, and best practices related to radiation planning, response, recovery

9. Recent and Upcoming NARR Projects • Interactive Sessions/Webinars • Poison Control Center Collaborations with Public Health- 2013 • Radiation and Public Health Legal Considerations-2013 • REP/Hostile Action Based Exercises- forthcoming 2014 • Laboratory Prioritization Considerations • Medical Community Education Project • Passenger Screening • Tabletop Exercise • Development of New Guidelines • Functional Exercise forthcoming

10. Traveler Screening- Federal Agencies DHS, US Customs and Border Protection (CBP) DHHS, CDC, Division of Global Migration and Quarantine (DGMQ) DHHS, CDC, Division of Environmental Hazards and Health Effects (EHHE)

11. Passenger Screening Procedure • CBP routinely employs a variety of radiation-detection technology at POEs to detect the presence of radioactive materials or contamination. • Use personal radiation detectors • To locate the source of an alarm, CBP officers use radiation isotope-identification devices to identify level and type of radiation to determine source

12. Travelers Screening • March 12-16, 2011 • No comprehensive radiological contamination screening plan • CBP identified three externally contaminated travelers • March 23, 2011 CDC and CBP implemented entry screening atPOE • Enhanced screening at the mainland airports receiving direct flights from Japan. • March 23 to April 30, 2011, CBP used the protocol to screen approximately 543 000 travelers for radioactive contamination who were arriving directly from Japan at 25 US airports • no travelers with contamination levels that warranted a public health response.

14. Traveler with Radioactive Contamination Detected by US Customs and Border Protection (CBP) Counts ≤2x Background Counts >2x and <20x Background Counts ≥20x Background Change Clothes and Rescreen CBP/CDC Contacts State Radiation Control Immediately <2x Background >20x Background Traveler Released with Information CBP Sends Contact and Screening Information to CDC State Radiation Control Assessment and Possible Intervention Passenger Released with Information If consent obtained >2x and <20x Background • Potential Follow-up Activities: • Radiation rescreening • Epidemiologic assessment • Urine collection for CDC bioassay State Public Health and Radiation Control Perform Follow-up CDC Contacts State Public Health

15. Public Health Follow-Up • CDC disseminated guidance and tools to state radiation control programs and state and local public health officials. • epidemiologic assessment form • recommendations for state radiation control program officers • materials and instructions for collecting urine specimens

16. Follow-Up Assessment • Performed by radiation control program • External decontamination • Epidemiological assessment • Thyroid count • Bioassay

17. External Decontamination • At the airport • Wash hands and face • Change clothes • At home • Full shower • Repeat gentle washing • No special considerations for drain water or shavings • Confirmed effectiveness by state radiation control program

18. Epidemiologic Assessment Form Contact information Flight information Proximity to source release Travel details

19. Thyroid Count • Gamma detection instrument next to the patient’s neck • If patient’s thyroid count is higher than background, it is indicative of radioactive iodine uptake • Follow up with their physician for clinical evaluation

20. Bioassay • Urine bioassay can help identify if a traveler has internal contamination • Subset of travelers who were close to the source

22. Traveler Screening Tabletop Exercise • Purpose • Identify key activities associated with traveler screening at an airport following an incident involving radiological contamination in another country • Validate and identify improved passenger screening protocols • Goal • Enhance preparedness of federal, state, and local responders responsible for coordinating and conducting traveler screening at US airports following a radiological release

23. Public Health Capabilities Emergency operations and coordination Emergency public information and warning Information sharing Non-pharmaceutical interventions Public health surveillance and epidemiological investigation Responder safety and health

24. Exercise Objectives Understand and/or identify state and local response requirements Clarify response roles and communication channels Inform next steps from epidemiologic assessment Identify key topics for public information releases Identify information to distribute to passengers and those potentially exposed at the airport

25. Scenario • Explosion at a nuclear power plant in South Korea • Prior to screening passengers are boarding flights headed to the U.S. • 261 passengers on Plane 1 • 290 passenger on Plane 2 • Both flights will land in 18-20 hours from now

26. Emergency Management Questions • How would notification occur? • Which agencies? • Which agency is the lead agency? • What protocols exist? • Passenger screening? • Decontamination? • Lab testing? • Passenger information? • Who will staff the arrival of the flights?

27. Communication Questions • Calls from the families of passengers • Is my family member safe? • Have they been exposed? • Will they expose me? • What should I do with their luggage? • Can we get potassium iodide? • Questions from airport staff • Questions from the public

28. Screening and Epidemiological Assessment Questions • How will passengers be processed as they deplane? • Screening for internal/external contamination • Will the passengers be isolated as they deplane? • Which local/state public health authority and statues can be enforced? • Are there any precautions taken to protect airport workers?

29. Bioassay Questions • Will the passengers be asked to provide clinical samples? • How will they be processed, transported, and reported? • What data should be collected along with the samples for prioritization in analysis? • Who will cover the cost of sample testing?

30. Legal and Financial Questions What if a passenger refuses screening? Who will cover the cost of laboratory testing and follow- up tests? If a passenger misses a connecting flight due to screening and is stranded, who is responsible for hosting the passenger?

31. Travelers Screening Initiative Provides a cohesive guidance document to address screening and decontaminating travelers as necessary during a radiological contamination release in another country. Addresses all Ports of Entry into the U.S.

32. Travelers Screening Initiative • 4 work groups • Emergency Management • Epidemiology/Surveillance • Bioassay • Communications

33. Travelers Screening Initiative Finalization of drafts to occur in late April Final draft version to be cleared by CDC and DHS