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Suggested Citation:"Appendix C: Workshop Agenda." Institute of Medicine. 2014. Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18347.
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Suggested Citation:"Appendix C: Workshop Agenda." Institute of Medicine. 2014. Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18347.
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Page 104
Suggested Citation:"Appendix C: Workshop Agenda." Institute of Medicine. 2014. Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18347.
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Page 105
Suggested Citation:"Appendix C: Workshop Agenda." Institute of Medicine. 2014. Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18347.
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Page 106
Suggested Citation:"Appendix C: Workshop Agenda." Institute of Medicine. 2014. Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18347.
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Page 107
Suggested Citation:"Appendix C: Workshop Agenda." Institute of Medicine. 2014. Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18347.
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Page 108
Suggested Citation:"Appendix C: Workshop Agenda." Institute of Medicine. 2014. Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18347.
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Page 109
Suggested Citation:"Appendix C: Workshop Agenda." Institute of Medicine. 2014. Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18347.
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Page 110
Suggested Citation:"Appendix C: Workshop Agenda." Institute of Medicine. 2014. Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18347.
×
Page 111
Suggested Citation:"Appendix C: Workshop Agenda." Institute of Medicine. 2014. Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18347.
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Page 112
Suggested Citation:"Appendix C: Workshop Agenda." Institute of Medicine. 2014. Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18347.
×
Page 113
Suggested Citation:"Appendix C: Workshop Agenda." Institute of Medicine. 2014. Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18347.
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Page 114

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C Workshop Agenda Day 1 January 23, 2013 Omni Shoreham Hotel 2500 Calvert Street, NW Washington, DC 20008 The Blue Room 8:00 a.m. Welcome and Introductions JACK HERRMANN, Workshop Co-Chair Senior Advisor and Chief, Public Health Preparedness National Association of County and City Health Officials (NACCHO) Washington, DC JOHN L. HICK, Workshop Co-Chair Associate Medical Director for Emergency Medical Services Medical Director of Emergency Preparedness Hennepin County Medical Center Minneapolis, MN 103

104 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK SESSION I: INTRODUCTION OF PUBLIC HEALTH AND LOGISTICAL CONSIDERATIONS AFTER AN IND INCIDENT Session Objective: x Understand the differences between types of nuclear incidents and implications of an improvised nuclear device (IND) attack on comprehensive planning and public health morbidity and mortality for neighboring jurisdictions. 8:10 a.m. Planning and Response Considerations to Optimize Survivability in Neighboring Jurisdictions and Important Response Priority Differences BROOKE BUDDEMEIER Health Physicist Lawrence Livermore National Laboratory Key Response Planning Factors for the Aftermath of Nuclear Terrorism 8:45 a.m. White Paper Presentation: The Impact of Mass Evacuations on Host Communities Following Nuclear Terrorism IRWIN REDLENER Director National Center for Public Health Preparedness 9:15 a.m. Discussion with Attendees 9:30 a.m. BREAK

APPENDIX C 105 SESSION II: FEDERAL PERSPECTIVE AND EXISTING PLANNING EFFORTS FOR PREPARING NEIGHBORING JURISDICTIONS Session Objectives: x Discuss what resources and tools already exist at federal level. x Examine differences and issues for requesting federal assets for neighboring communities. x Understand barriers to interactions and exchanging of information. x Discuss what fundamental regional planning has been done at the federal level, and what methods of inclusion were used for communities outside of detonation site. 9:45 a.m. Panel Discussion: Existing Federal Guidance on INDs and Challenges to Operations in Communities Outside Detonation Site GEORGE KORCH Deputy Assistant Secretary Office of the Assistant Secretary for Preparedness and Response Department of Health and Human Services ROBERT C. WHITCOMB Lead Physical Scientist Radiation Studies Branch Centers for Disease Control and Prevention ROBERT FARMER Director, Operations Division Response Directorate Federal Emergency Management Agency JODY WIREMAN, Forum Member Director Force Health Protection Division U.S. Northern Command 10:45 a.m. Discussion with Attendees

106 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK 11:05 a.m. Panel Discussion: Planning for an IND Detonation: Local, State, and Regional Perspectives Moderator: MITCH STRIPLING Director of Emergency Planning New York City Department of Health and Mental Hygiene Panelists: ANDREW VELASQUEZ III Regional Administrator, Region V Federal Emergency Management Agency ALONZO PLOUGH Director of Emergency Preparedness and Response Los Angeles County Department of Public Health ROBERT LEVIN Medical Director and Health Officer Ventura County Public Health, California MORDECHAI GOLDFEDER Senior Health and Medical Planner New York City Office of Emergency Management 12:15 p.m. Discussion with Attendees 12:30 p.m. LUNCH SESSION III: RESPONSE CHALLENGES FOR NEIGHBORING COMMUNITIES AFTER AN IND DETONATION Session Objectives: x Consider responsibilities of agencies and frameworks for command, control, and communications. x Emphasize continuity of operations planning with spillover to adjacent jurisdictions or states and other actions or supports.

APPENDIX C 107 x Explore opportunities to increase collaboration and cooperation between and within states and regions to support affected areas. x Consider mechanisms of coordinating concise, coherent, and consistent messaging across agencies for the public to follow. 1:30 p.m. White Paper Presentation: Implications of an Improvised Nuclear Device Detonation on Command and Control for Surrounding Regions at the Local, State, and Federal Levels DAVE PASQUALE Senior Operations Specialist RICK HANSEN Senior Scientist Counter Terrorism Operations Support Center for Radiological/Nuclear Training at the Nevada National Security Site National Security Technologies, LLC 2:00 p.m. Discussion with Attendees 2:20 p.m. Panel Discussion: Maintaining Command and Control After an IND Detonation ROBERT FARMER Director, Operations Division Response Directorate Federal Emergency Management Agency JONATHON MONKEN Director Illinois Emergency Management Agency JOHN F. KOERNER Chief, Chemical, Biological, Radiological, Nuclear, or High-Yield Explosives (CBRNE) Branch Office of Preparedness and Emergency Operations Deputy Assistant Secretary for Preparedness and Response

108 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK 3:00 p.m. Discussion with Attendees 3:20 p.m. BREAK 3:35 p.m. Panel Discussion: Risk Communication Strategies in the Aftermath of a Nuclear Terrorist Attack; Getting the Public’s Attention CHARLES MILLER Chief, Radiation Studies Branch Division of Environmental Hazards and Health Effects Centers for Disease Control and Prevention STEVEN M. BECKER Professor of Community and Environmental Health College of Health Sciences Old Dominion University BRUCE FOREMAN Radiation Communication Specialist CBRNE Branch Federal Emergency Management Agency ED MCDONOUGH Public Information Officer Maryland Emergency Management Agency 4:35 p.m. Discussion with Attendees 5:00 p.m. ADJOURN

APPENDIX C 109 Day 2 January 24, 2013 Omni Shoreham Hotel 2500 Calvert Street, NW Washington, DC 20008 The Blue Room 8:00 a.m. Welcome and Introduction JACK HERRMANN, Workshop Co-Chair Senior Advisor and Chief, Public Health Preparedness NACCHO, Washington, DC JOHN L. HICK, Workshop Co-Chair Associate Medical Director for Emergency Medical Services Medical Director of Emergency Preparedness Hennepin County Medical Center, Minneapolis, MN SESSION IV: CONSIDERATIONS FOR THE PUBLIC HEALTH SHELTERING AND MASS MANAGEMENT ROLE Session Objectives: x Discuss added challenges of sheltering evacuees related to an IND attack compared to routine emergency sheltering. x Examine roles of Community Reception Centers and Family Assistance Centers in neighboring areas. x Examine radiological assessment tools being researched and developed for future use. x Consider the integration and operation of the Radiation Injury Treatment Network, National Disaster Medical System, and emergency medical services into the health care system after an incident.

110 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK 8:10 a.m. Session Introduction and Objectives ARMIN ANSARI Radiation Studies Branch, National Center for Environmental Health Centers for Disease Control and Prevention 8:20 a.m. Panel Discussion: Operationalizing Community Reception Centers for Evacuees After a Nuclear Incident at Various Distances from Detonation Site JOHN WILLIAMSON Administrator, Environmental Radiation Programs Bureau of Radiation Control Florida Department of Health RUTH MCBURNEY Executive Director Conference of Radiation Control Program Directors ONORA LIEN Health System Planning Manager Northwest Healthcare Response Network Public Health–Seattle & King County RODNEY WALLACE Chief, Division of Chemical, Biological, Radiological and Nuclear (CBRN) Medical Countermeasures Diagnostics Division of CBRN Countermeasures Biomedical Advanced Research and Development Authority Office of the Assistant Secretary for Preparedness and Response U.S. Department of Health and Human Services 9:20 a.m. Discussion with Attendees 9:45 a.m. BREAK

APPENDIX C 111 10:00 a.m. Panel Discussion: Opportunities for Integration Between Disaster Transport Systems Moderator: GAMUNU WIJETUNGE, Forum Member Office of Emergency Medical Services National Highway Traffic Safety Administration Panel: DAN WEISDORF Executive Committee Radiation Injury Treatment Network ANDY GARRETT National Disaster Medical System and Joint Patient Assessment & Tracking System Office of the Assistant Secretary for Preparedness and Response Department of Health and Human Services DONALD DONAHUE Member, American Board of Disaster Medicine Managing Partner, Diogenec Group, LLP 11:00 a.m. Discussion with Attendees 11:30 a.m. LUNCH SESSION V: CONSIDERATIONS FOR HEALTH CARE SYSTEMS IN NEIGHBORING AREAS TO THE INCIDENT Session Objectives: x Examine systems available for guidance of reception centers and involvement with the larger radiation injury health care network. x Discuss immediate needs of patients and victims, including mental health and ongoing patient tracking. x Discuss best practices for adapting guidance to the public health field and managing mass medical centers and incidents.

112 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK x Explore issues of health care workforce protection after an IND incident. 12:30 p.m. Panel Discussion: Challenges and Guidance Associated with Hospitals/Mass Medical Care Sites in Neighboring Jurisdictions NORM COLEMAN Senior Medical Advisor and Chief, CBRN Team Office of Assistant Secretary for Preparedness and Response ANN NORWOOD Senior Associate UPMC Center for Health Security THOMAS LANGER Director, Bureau of Environmental Health Kansas Department of Health and Environment CAPT. JIM SPAHR Associate Director National Institute for Occupational Safety and Health Office for Emergency Preparedness and Response Centers for Disease Control and Prevention 1:30 p.m. Discussion with Attendees SESSION VI: NEXT STEPS—THE ROLE OF REGIONAL HEALTH CARE COALITIONS IN RESPONSE Session Objectives: x Discuss benefits of regional health care coalitions and their potential to coordinate clinical care guidance and triage decisions. x Understand the special needs of exposed or irradiated patients presenting at hospitals.

APPENDIX C 113 2:00 p.m. Session Introduction DAVID MARCOZZI, Forum Member Director, National Healthcare Preparedness Programs Assistant Secretary of Preparedness and Response Department of Health and Human Services 2:10 p.m. White Paper Presentation: Role of Regional Healthcare Coalitions in Managing and Coordinating Disaster Response DAN HANFLING, Forum Member Special Advisor Emergency Preparedness and Response Inova Health Systems 2:40 p.m. Discussion with Attendees 3:00 p.m. BREAK 3:15 p.m. Panel Presentation: Roles and Potential for Health Care Coalitions ERIC TONER, Forum Member Senior Associate UPMC Center for Health Security DAVID WEINSTOCK Medical Advisor Radiation Injury Treatment Network JENNY ATAS Medical Director Region 2 South Healthcare Coalition, Michigan 4:00 p.m. Discussion with Attendees

114 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK 4:20 p.m. Next Steps: Report from Session Chairs on Key Takeaway Messages x What issues have not been addressed? x How can people engage their communities to pass on lessons learned? 4:45 p.m. ADJOURN

Next: Appendix D: Biographical Sketches of Speakers and Panelists »
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Our nation faces the distinct possibility of a catastrophic terrorist attack using an improvised nuclear device (IND), according to international and U.S. intelligence. Detonation of an IND in a major U.S. city would result in tens of thousands to hundreds of thousands of victims and would overwhelm public health, emergency response, and health care systems, not to mention creating unprecedented social and economic challenges. While preparing for an IND may seem futile at first glance, thousands of lives can be saved by informed planning and decision making prior to and following an attack.

In 2009, the Institute of Medicine published the proceedings of a workshop assessing the health and medical preparedness for responding to an IND detonation. Since that time, multiple federal and other publications have added layers of detail to this conceptual framework, resulting in a significant body of literature and guidance. However, there has been only limited planning effort at the local level as much of the federal guidance has not been translated into action for states, cities and counties. According to an informal survey of community preparedness by the National Association of City and County Health Officials (NACCHO), planning for a radiation incident ranked lowest in priority among other hazards by 2,800 local health departments.

The focus of Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary is on key response requirements faced by public health and health care systems in response to an IND detonation, especially those planning needs of outlying state and local jurisdictions from the detonation site. The specific meeting objectives were as follows:

- Understand the differences between types of radiation incidents and implications of an IND attack on outlying communities.

-Highlight current planning efforts at the federal, state, and local level as well as challenges to the implementation of operational plans.

-Examine gaps in planning efforts and possible challenges and solutions.

-Identify considerations for public health reception centers: how public health and health care interface with functions and staffing and how radiological assessments and triage be handled.

-Discuss the possibilities and benefits of integration of disaster transport systems.

-Explore roles of regional health care coalitions in coordination of health care response.

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