As natural and manmade disasters increase in intensity, the need for hospital preparedness plans, as well as mass relocation plans, becomes critical when taking into account the public health and medical needs of at-risk individuals and groups in the event of a public health emergency. With respect to public health emergency management and treatment capabilities, the development and rapid distribution of medical countermeasures during CBRN (chemical, biological, radiological, nuclear) incidents becomes crucial. Medical countermeasures implemented by a jurisdiction in response to a CBRN incident could include staffing plans for hospitals, vaccines, and prophylaxis as well as measures to ensure the mental health of citizens.
In 2008, the University of Alabama at Birmingham conducted a study of nurses and emergency department physicians. The purpose of the study was to analyze the perceptions, concerns, and information needs of the focus-group participants and list some staffing challenges that hospitals would probably experience following a radiological emergency. The Lessons Learned Information Sharing (LLIS.gov) Best Practice, Mass Evacuation Reception Planning: Overview of Planning Issues After a Nuclear Incident (available on LLIS.gov), reviews this survey – in conjunction with other reports – to determine the critical functions that responders, receivers, and other essential personnel may be unwilling to perform.
The study – titled Improving Hospital Preparedness for Radiological Terrorism: Perspectives from Emergency Department Physicians and Nurses – concludes that participants “expressed deep concerns about a range of specific issues. Topping the list was the expectation that the hospital would be overwhelmed by a combination of injured people, contaminated people, and people fearful that they had been exposed or contaminated. The second highest ranked concern for focus group participants related to the safety and well-being of loved ones. Clinicians expressed a powerful commitment to professional duties and responsibilities, but often also indicated that family came first.”
GAO: Smaller vs. Larger, But a Drop-off in Experience
In addition to medical staff being fearful and potentially unwilling to participate in nuclear incident response efforts, the federal government faces additional challenges in acquiring the medical prophylaxis needed to deal with such incidents. The Government Accountability Office (GAO) issued a report on 13 April 2011 – Public Health Preparedness: Developing and Acquiring Medical Countermeasures Against Chemical, Biological, Radiological, and Nuclear Agents (also available on LLIS.gov) – addressing the need for additional research and development on the problems involving in acquiring medical countermeasures.
The findings of the GAO report indicate that the market for medical countermeasures attracts smaller biotechnology firms, rather than larger pharmaceutical firms, for development in large part because of the failure rate for development and licensure for most drug vaccines. However, the downside for using smaller firms is that HHS (the U.S. Department of Health and Human Services) must provide more guidance to the less experienced companies. When using smaller firms, therefore, it is prudent to plan for additional challenges in the mitigation process – e.g., providing animal countermeasures, determining the appropriate dosage of countermeasures for children, and conducting safety evaluations of countermeasures that have not yet been licensed.
Drugs, vaccines, and diagnostic devices are all important, and predominantly recognized as medical countermeasures; however, psychological management following a nuclear incident is also an important aspect of incident response. A closely related LLIS.gov Best Practice – Radiological Dispersal Device Incident Response Planning: Psychological Management – provides an overview of issues and procedures that jurisdictions should consider when pre-planning for the psychological management of RDD (radiological dispersal device) victims, emergency responders, and the general public. As this Best Practice states, “Planners must consider that the behavioral responses of individuals and groups immediately after an RDD incident can complicate or impede emergency response operations.” RDD incidents also trigger mass anxiety and stress, and in many jurisdictions probably could overwhelm critical services.
A separate publication – the National Nuclear Security Administration’s Emergency Operations Training Academy’s RAP171DW: Crime Scene Issues, Hazards, and Law Enforcement Interface guide – points out that “the psychological impact of the dispersion of radiological material into the community will far outweigh the impact of the [dirty bomb] explosion.” Because the general public has very little knowledge of the hazards and effects of nuclear materials, it becomes imperative for emergency response personnel to understand psychological and behavioral responses unique to radiation exposure in order to effectively start behavior countermeasures for a successful nuclear response effort.
For additional information on the preceding and other medical countermeasures documents, log into LLIS.gov at www.llis.dhs.gov.
Sophia Paros, a contractor with SAIC, serves as the operations lead for Lessons Learned Information Sharing (LLIS.gov), the DHS/FEMA (Department of Homeland Security/Federal Emergency Management Agency) national online network of lessons learned, best practices, and innovative ideas for the nation’s homeland-security and emergency management communities. Paros has received a dual bachelor’s degree in Computer Information Systems and Business from the College of Notre Dame of Maryland, and is currently working on an M.S. in Information Assurance from The George Washington University.