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Suggested Citation:"Appendix E: Resource List." 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 E: Resource List." 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 144
Suggested Citation:"Appendix E: Resource List." 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 145
Suggested Citation:"Appendix E: Resource List." 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 146
Suggested Citation:"Appendix E: Resource List." 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 147
Suggested Citation:"Appendix E: Resource List." 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 148

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E Resource List INTRODUCTION Assessing Medical Preparedness to Response to a Terrorist Nuclear Event: Workshop Summary. IOM (Institute of Medicine): http://www. nap.edu/catalog.php?record_id=12578. The Bridge, Linking Engineering and Society: Summer 2010, Nuclear Dangers. Volume 40, Number 2. A publication of the National Acade- my of Engineering, this issue contains a collection of articles on some of the major aspects of current nuclear threats and current research and guidance. Can be downloaded at http://www.nae.edu/TheBridge. For public health information, an entire edition of the journal for Disaster Medicine and Public Health Preparedness was dedicated to the public health issues associated with the aftermath of nuclear terrorism. All of the articles are available for free download from http://www.dmphp. org/content/vol5/Supplement_1/index.dtl. SESSION 1 Key Response Planning Factors for the Aftermath of Nuclear Ter- rorism was developed by Lawrence Livermore National Laboratory (LLNL) in support of the Department of Homeland Security Office of Health Affairs. It was released in August 2009 and identified key re- sponse issues. https://narac.llnl.gov/uploads/IND_ResponsePlanning_ LLNL-TR-410067web.pdf. 143

144 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK National Council on Radiation Protection and Measurement (NCRP) Report No. 165—Responding to a Radiological or Nuclear Terrorism Incident: A Guide for Decision Makers was released in February 2011 and is a National Standard that supplies the science and builds on many of the concepts of the Planning Guidance. (This document must be pur- chased.) http://www.ncrppublications.org/Reports/165. Public Health and Medical Implications Faced by Neighboring Communities After an IND Detonation. White paper commissioned for the improvised nuclear device (IND) workshop, authored by Irwin Redlener, available for download from the attachments menu on the right side of the meeting webpage at http://www.iom.edu/Activities/PublicHealth/ MedPrep/2013-JAN-23.aspx. SESSION 2 Planning Guidance for Response to a Nuclear Detonation was devel- oped by the Homeland Security Council (2nd ed., June 2010). This inter- agency consensus document provides excellent background information on the effects of a nuclear detonation and key response recommendations. Its definition of zones (damage and fallout) is becoming the standard for response planning and should be integrated in the planning process. https://responder.llnl.gov/data/assets/docs/publications/Planning_Guidance_ for_Response_to_a_Nuclear_Detonation-2nd_Edition_FINAL.pdf. SESSION 3 Implications of an Improvised Nuclear Device on Command and Control for Surrounding Regions at the Local, State and Federal Levels: White paper commissioned for the IND workshop, authored by Rick Hansen and Dave Pasquale, of National Security Technologies, LLC. Can be downloaded from the attachments menu on the right side of the meeting webpage at http://www.iom.edu/Activities/PublicHealth/ MedPrep/2013-JAN-23.aspx. Health Effects Message Testing: Detonation of Improvised Nuclear Device, National Center for Environmental Health, Radiation Studies Branch, U.S. Centers for Disease Control and Prevention. January 2012.

APPENDIX E 145 http://emergency.cdc.gov/radiation/pdf/Health%20Message%20Testing- Detonation%20of%20an%20Improvised%20Nuclear%20Device.pdf. CDC Radiation Emergencies. Information for Media and Communi- cation Professionals. http://emergency.cdc.gov/radiation/media.asp. SESSION 4 A Plan for Incorporating Local Volunteer Radiation Professionals into Existing Health Volunteer Programs to Assist in Population Monitoring, March 2011. Gives background and summary for five state initiatives, and lessons learned. Prepared for the CDC by the Conference of Radiation Control Program Directors (CRCPD): http://www.crcpd. org/Homeland_Security/RRVC_FinalReport.pdf. Radiation Injury Treatment Network (RITN) Center Locations Map: http://ritn.org/WorkArea/DownloadAsset.aspx?id=2147483953. SESSION 5 Radiation Emergency Medical Management (REMM) Website: Guidance on Diagnosis and Treatment for Healthcare Providers: New features as of 12/2012 include creation of multimedia library, YouTube channel, updates to key pages, and a mobile version of the site: http://www.remm.nlm.gov/nuclearexplosion.htm. Materials from Amber Waves 2012: a series of workshops, training events, and tabletop exercises addressing the response of multiple federal, state, and local agencies to a radiological terrorism event across two states. For more information, contact Thomas Langer (speaker), Tlanger@kdheks.gov, or Kim Steves, Ksteves@kdheks.gov. National Alliance for Radiation Readiness (NARR): A coalition of public health, health care, and emergency management organizations. These organizations represent practitioners in the field of radiation readi- ness, including state and local public health practitioners; elected offi- cials at the state and local level; and first responder and first receiver groups. Reps of federal agencies participate as liaison members. http://www.radiationready.org.

146 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK National Council on Radiation Protection and Measurement (NCRP) Report No. 138—Management of Terrorist Events Involving Radioactive Material, was released in 2001 with recommendations on training guidelines, critical resources, and guidelines for internal and external exposure, as well as decontamination and cleanup. (This document must be purchased.) http://www.ncrppublications.org/Reports/138. Emergency Responder Health Monitoring and Surveillance: NRT Technical Assistance Document and A Guide for Key Decision Makers were created in response to the continuing need for health monitoring and surveillance for emergency response workers by a consortium of federal agencies, state health departments, and volunteer responder groups that was convened by the National Institute for Occupational Safety and Health (NIOSH). Both documents can be downloaded at http://nrt.sraprod.com/erhms. SESSION 6 Role of Regional Healthcare Coalitions in Managing and Coordinat- ing Disaster Response: White paper commissioned for IND workshop, authored by Dan Hanfling, M.D., Special Advisor to Inova Health Sys- tems for Emergency Preparedness and Response. Can be downloaded from the attachments menu on the right side of the meeting webpage at http://www.iom.edu/Activities/PublicHealth/MedPrep/2013-JAN-23.aspx. Rad Resilient City: A Preparedness Checklist to Save Lives After a Nuclear Detonation, published by the UPMC Center for Health Security, provides cities and their neighbors with a checklist of preparedness actions that could save tens of thousands of lives or more following a nuclear terrorist attack. The workbook includes a wealth of background information, a phased implementation plan, guidance for using buildings as shelters, a community preparedness education plan, and guidelines for developing and samples of post-event messages to guide and save lives. http://www.radresilientcity.org/pdf/2011-09-27- RRC.html. After Action Report and Improvement Plan from Region 2 South (Michigan) Bio-Defense Network Full-Scale Exercise for Operation Shared Burden, developed to assess abilities for current response capabilities

APPENDIX E 147 for a terrorist incident involving the detonation of an improvised nuclear device within the Detroit Metropolitan Area. Hard copy can be found by contacting Jenny Atas (speaker), Jatas@dmc.org, or Mark Sparks, Msparks@2south.org.

Next: Appendix F: List of Speakers and Registered Attendees »
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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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