ESF#8 Tools for the Nuclear Response
John F. Koerner, MPH, CIH Chief CBRNE Branch
Division of Preparedness Planning Office of Preparedness & Emergency Operations
Public Health & Radiation Emergency Preparedness Conference
The views and opinions expressed in this presentation are strictly that of the presenter and are not necessarily the views of ASPR, the Department of Health and Human Services, or the United States Government. No endorsement of products is implied.
CBRNE Branch Mission
1. To provide health-related CBRNE subject matter and operational expertise across the spectrum of ASPR preparedness planning and response To recognize, anticipate, and evaluate gaps in the Nations systems for medical and public health response to CBRNE events through cooperative professional interactions Development of innovative, evidence-based interventions to strengthen the Nations medical and public health emergency response
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Learning Objectives Introduce and describe evidence-based tools, systems and guidance
State/Local Planners Playbook for Medical Response to an IND Radiological Emergency Medical Management (REMM) MedMap Rad-LN
Key principles - medical and public health response to nuclear detonation A partnership of SMEs from the Nuclear Detonation Scarce Resources Working Group Offered as a guide to link State, local, and ESF #8 planning
Web-based, interactive format or downloadable
A living document - updated periodically we want your comments
Reference - Murrain-Hill P, Coleman CN, Hick JL, Redlener I, Weinstock DM, Koerner JF, Black D, Sanders M, Bader JL, Forsha J, Knebel AR. Medical Response to a Nuclear Detonation: Creating a Playbook for State and Local* Planners and Responders. Disaster Med Pub Health Prep. 2011.
What do I do?
Action Steps
Sequential guidance to coordinate the medical response to a nuclear detonation Detailed time-phased, sector-oriented approaches to response activities with linked references.
General Readiness Planning and Emergency Management Emergency Medical Services (EMS) Health and Facility Response, Public Health Medical System Response Evacuee Medical Care and Fallout-related Illness Recovery
Typical Action Screen
REMM
Radiological Emergency Medical Management (REMM)
ASPR/NIH Managed Collaboration consultation with experts across the spectrum Goals Provide guidance to healthcare workers regarding diagnosis and
treatment Just-in-time, evidence based information to enhance understanding Web-based, multi-platform download
Updates iPhone App, Blackberry, Palm, and Windows mobile New videos, animations, and illustrations Updated models, tools, and algorithms Triage tool
www.remm.nlm.gov
REMM
Clinical Triage Tool
Basis Casagrande R, Wills N, Kramer E, Sumner L, Mussante M, Kurinsky R, McGhee P, Katz L, Weinstock DM, Coleman CN. Using the Model Of Resource and Time-based Triage (MORTT) to Guide Scarce Resource Allocation in the Aftermath of a Nuclear Detonation. Disaster Med Pub Health Prep. 2011. Coleman CN, Casagrande R, Hick JL, Weinstock DM, Bader JL, Chang F, Nemhauser JB, Knebel AR. Triage and Treatment Tools for Use in a Scarce Resources - Crisis Standards of Care Setting following a Nuclear Detonation. Disaster Med Pub Health Prep. 2011.
REMM
Clinical estimation of dose from exposure
MedMap
Integrated Approach to Decision Support Incorporates GIS and health-related databases from Federal and Private-sector sources (HSIP, FRMAC) Uses 8 or 10-point grid and validation (Fusion Cell) Can be updated at SOC or User level Rapid proof of concept 3 months Demonstrable utility Haiti
Updated damage image within 48 hours Fusion did analysis damaged structures routes Improvised collection points IRCT provided updates from user end
MedMap
MedMap
Rad-LN
Primary Objectives
Establish National Capability with International Co-operation Deployable Laboratories Core Laboratory Network: Cytogenetic and Radiobioassay Analysis High Throughput Biodosimetry
This is a developing concept and not an official project
Rad-LN
Radiobioassay CDC Core Lab and other health physics labs (NIH Radiation Safety, nuclear medicine departments, state laboratories, and Canadian laboratories) Cytogenetic biodosimetry up to 500,000 samples - acute management and risk assessment Hematology CBC >100,000 per day. Novel approaches such as mobile laboratories. Ongoing optimization and improvement of existing techniques Surge capacity for radiobioassay, biodosimetry, and sample tracking Oversight committee Standardization, exercise and assuring that there is a balanced investment International collaboration
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Rad-LN
Novel Molecular Diagnostics
PARTNERS - ASPR - CDC - NIH (NIAID, NCI) - BARDA - AHRQ - DOD (DTRA, AFFRI) - VA - DHS (FEMA, DNDO, S and T)
Triage
Dose Estimate
Medical Managemen Epidemiology t
Radiatio n Laborato ry Network (Rad-LN)
Hematology Cytogenetic Biodosimetry Radiobioassay
AUTOMATION & HIGH THROUGHPUT
