WORKSHOP OBJECTIVES:
The purpose of the workshop was to assess the current level of medical preparedness for a nuclear detonation of up to 10 kilotons in tier 1 Urban Area Security Initiative cities (New York/New Jersey; National Capitol Region; Houston; Chicago; Los Angeles; and San Francisco/Bay Area). The specific objectives of the workshop were to:
--Review and summarize the overall emergency response activities, and available healthcare capacity (including shelter, evacuation, decontamination, and medical infrastructure interdependencies) to treat the affected population;
--Examine the capacity and identify gaps in the capability of the federal, state, and local authorities to deliver available medical countermeasures in a timely enough way to be effective;
--Review and summarize available treatments for pertinent radiation illnesses including the efficacy of medical countermeasures; and,
--Appraise the expected benefit of medical countermeasures, including those currently under development.
DAY 1 AGENDA
8:30 a.m. Welcome, Introductions, and Overview of Workshop Purpose and Objectives
Georges Benjamin, Committee Chair, Executive Director, American Public Health Association
Session 1:
CURRENT PREPAREDNESS FOR AN IMPROVISED NUCLEAR DEVICE, PART 1: IMMEDIATE CASUALTIES
Session Objective: In response to the committee's statement of task, this session will explore the current level of medical preparedness for detonation of an improvised nuclear device (IND) of up to 10 kilotons (kT) in yield in a tier 1 Urban Area Security Initiative (UASI) area. Panels of local, state, and federal emergency response and medical personnel will review overall emergency response preparedness and capacity of the healthcare system to treat the population injured by the blast, thermal, and prompt radiation from an IND detonation, including capacity of EMS to triage, treat, and transport the injured to treatment facilities and capacity of the healthcare system to provide appropriate medical care to the numbers, types, and severities of likely injuries. The panels will address four aspects of emergency response preparedness: (1) capacity of the emergency medical response to reach the injured and perform field triage and treatment, (2) capacity to transport injured to area healthcare facilities, (3) capacity of area healthcare facilities to evaluate and treat the likely numbers and types of injuries, and (4) capacity to evacuate seriously injured to appropriate healthcare facilities nationally.
8:55 a.m. Session Overview and Objectives
George Annas, Session Moderator, Edward Utley Professor and Chair, Department of Health Law, Bioethics & Human Rights, Boston University School of Public Health
9:00 a.m. Panel 1. Preparedness for emergency response to detonation of a 10 kT IND (i.e., what capability is there to reach, triage, and treat those injured by the detonation safely?)
Brooke Buddemeier, Lawrence Livermore National Laboratory
Michael Fitton, New York (Fire Department of New York)
Joseph Newton, Chicago (Chicago Fire Department)
Richard Zuley, Chicago (Chicago Department of Public Health)
Jeanine Prud’homme, New York (NY City Department of Health & Mental Hygiene)
John Brown, San Francisco (San Francisco EMS Agency)
10:00 a.m. Panel 2. Preparedness to transport casualties to area treatment facilities (i.e., what capability is there to know which treatment facilities are open and what is the capacity to get them there?)
Douglas Havron, Houston (SE Texas Trauma Regional Advisory Council)
Bryan Hanley, Los Angeles (Los Angeles County EMS Agency)
Craig DeAtley, National Capital Region (Washington Hospital Center, DC)
Richard Alcorta, National Capital Region (Maryland Institute for EMS Systems)
Carl Lindgren, National Capital Region (Arlington Fire Department, Virginia)
11:00 a.m. BREAK
11:15 a.m. Panel 3. Preparedness of the metropolitan area’s medical system to treat casualties from a 10 kT IND
Amy Kaji, Los Angeles (Harbor-UCLA Medical Center)
Katherine Uraneck, New York (New York City Department of Health & Mental Hygiene)
Patricia Hawes, National Capital Region (Suburban Hospital Bethesda, Maryland)
John Brown, San Francisco (San Francisco EMS Agency)
Joseph A. Barbera, Institute for Crisis, Disaster, and Risk Management George Washington University, Washington, DC
Nathaniel Hupert, Weill Medical College of Cornell University, New York, NY
12:15 p.m. WORKING LUNCH TO CONTINUE PANEL DISCUSSIONS
1:00 p.m. Panel 4. Preparedness to evacuate serious casualties from a 10 kT IND from area hospitals to appropriate treatment facilities statewide and nationally
Katherine Uraneck, New York (New York City Department of Health & Mental Hygiene)
Dan Hanfling, National Capital Region (Fairfax County, Virginia)
Aashish Shah, Houston (Texas Department of State Health Services)
Frank Levy, Houston (Houston Department of Health and Human Services)
Joseph A. Barbera, George Washington University
Jerome Hauer, The Hauer Group
2:00 p.m. State of Preparedness for Immediate Casualties: An Open Discussion by Committee Members and Audience
3:00 p.m. BREAK
Session 2: CURRENTLY AVAILABLE MEDICAL RESOURCES
Session Objective: Discuss federal and state medical preparedness for an IND event in a tier 1 UASI area, the assets that will be available in such an event, and the plans to use those assets.
3:15 p.m. Session Overview and Objectives
Judith Monroe, Session Moderator,State Health Commissioner, Indiana State Department of Health, President, Association of State and Territorial Health Officials
3:20 p.m. HHS Response Assets and Plans in the Event of an IND Detonation
Ann R. Knebel, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services
3:35 p.m. DOE Response Assets and Plans in the Event of an IND Detonation
David R. Bowman, Consequence Management Program Manager, National Nuclear Security Administration
3:50 p.m. National Guard Response Assets and Plans in the Event of an IND Detonation
COL Daniel Bochicchio, U.S. Army War College
4:05 p.m. State Preparedness for an IND Event
James Blumenstock, Association of State and Territorial Health Officers
4:20 p.m. Discussion led by Judith Monroe, Session Moderator
5:20 p.m. ADJOURN
DAY 2 AGENDA
8:00 a.m. Welcome, Introductions, and Overview of Workshop Purpose and Objectives
Georges Benjamin, Committee Chair, Executive Director, American Public Health Association
Session 3: CURRENT PREPAREDNESS FOR AN IMPROVISED NUCLEAR DEVICE, PART 2: PREVENTING AND TREATING FALLOUT CASUALTIES
Session Objective: Discuss the preparedness of tier 1 UASI areas to manage the effects of the radiation fallout from a 10 kT IND and to identify, mitigate, and manage long-term effects. Issues include effectiveness of risk communication, short- and long-term mental health, efficacy of nonmedical protective actions such as sheltering in place and evacuation, and plans and expectations for state and federal response resources to augment local resources. This session will conclude with an assessment of what remains to be done.
8:30 a.m. Session Overview and Objectives
Coleen Conway-Welch, Session Moderator, Nancy and Hilliard Travis Professor of Nursing, and Dean, Vanderbilt University School of Nursing
8:35 a.m. Panel 5. Preparedness to mitigate, identify, and address fallout casualties and to manage long-term consequences.
Brooke Buddemeier, Lawrence Livermore National Laboratory
Reuben Varghese, National Capital Region (Arlington Public Health, Virginia)
Michael Welling, National Capital Region (Virginia Department of Health)
Thomas Ahrens, Los Angeles and San Francisco (California Department of Public Health)
Frank Levy, Houston (Houston Department of Health and Human Services)
Kathleen “Cass” Kaufman, Los Angeles (Los Angeles County Department of Public Health)
Adela Salame-Alfie, New York (NY State Department of Health)
Irwin Redlener, Columbia University
10:30 a.m. BREAK
10:45 a.m. State of Preparedness for Fallout Casualties: An Open Discussion by Committee Members and Audience
Session 4: SUMMARY
11:30 p.m. Wrap-up and final thoughts
Georges Benjamin, Committee Chair, Executive Director, American Public Health Association
12:00 p.m. ADJOURN WORKSHOP