1. An Update on Population Monitoring Activities at CDC Charles W. Miller, PhD Armin Ansari, PhD, CHP Radiation Studies Branch Division of Environmental Hazards & Health Effects National Center for Environmental Health Centers for Disease Control & Prevention Atlanta, Georgia Charles W. Miller, PhD Armin Ansari, PhD, CHP Radiation Studies Branch Division of Environmental Hazards & Health Effects National Center for Environmental Health Centers for Disease Control & Prevention Atlanta, Georgia

2. Overview What is “Population monitoring”? Who is responsible for it? Federal agency support, roles, responsibilities CDC’s efforts in the area of population monitoring What next? What is “Population monitoring”? Who is responsible for it? Federal agency support, roles, responsibilities CDC’s efforts in the area of population monitoring What next?

3. Potential Nuclear/Radiological Incidents Transportation Power Plant Weapons Laboratory Industrial Medical Space Terrorism Transportation Power Plant Weapons Laboratory Industrial Medical Space Terrorism

4. Terrorism Scenarios IND – Improvised Nuclear Device RDD – Radiological Dispersal Device –may or may NOT involve explosion RED – Radiological Exposure Device A device whose purpose is to expose people to radiation, rather than to disperse radioactive material. “silent source” IND – Improvised Nuclear Device RDD – Radiological Dispersal Device –may or may NOT involve explosion RED – Radiological Exposure Device A device whose purpose is to expose people to radiation, rather than to disperse radioactive material. “silent source”

5. Population Monitoring The process of identifying, screening, and monitoring people for exposure to radiation or contamination with radioactive materials.

6. Population Monitoring Evaluate potentially-affected population for: –Needed medical treatment (both rad and non-rad related) –Presence of contamination on body or clothing. –Intake of radioactive materials –Removal of external or internal contamination (decontamination) –Radiation dose received and the resulting health risk from the exposure –Long-term health effects (registry) Evaluate potentially-affected population for: –Needed medical treatment (both rad and non-rad related) –Presence of contamination on body or clothing. –Intake of radioactive materials –Removal of external or internal contamination (decontamination) –Radiation dose received and the resulting health risk from the exposure –Long-term health effects (registry)

7. Potential Impacts Nuclear Detonation –Hundreds of thousands of fatalities –Hundreds of thousands contaminated Explosive Radiological Dispersal Device –Hundreds of fatalities –Thousands contaminated Nuclear Detonation –Hundreds of thousands of fatalities –Hundreds of thousands contaminated Explosive Radiological Dispersal Device –Hundreds of fatalities –Thousands contaminated

8. American Red Cross Sheltering/Contamination Issues During the TOPOFF 2 exercise in Seattle, WA in 2003… “Before evacuated residents could enter the shelter, they first had to be examined for radioactive material” http://www.redcross.org/article/0,1072,0 _332_1153,00.html During the TOPOFF 2 exercise in Seattle, WA in 2003… “Before evacuated residents could enter the shelter, they first had to be examined for radioactive material” http://www.redcross.org/article/0,1072,0 _332_1153,00.html

9. Citizens Have Radiation Monitoring Instruments

10. Current Planning Guidance The Federal Emergency Management Agency has exercise evaluation criteria requiring that state emergency response plans demonstrate the ability to monitor 20% of the potentially exposed population within 12 hours upon arrival at a relocation center. Reference: “Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness in support of Nuclear Power Plants” NUREG-0645 FEMA-REP-1 Rev 11) The Federal Emergency Management Agency has exercise evaluation criteria requiring that state emergency response plans demonstrate the ability to monitor 20% of the potentially exposed population within 12 hours upon arrival at a relocation center. Reference: “Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness in support of Nuclear Power Plants” NUREG-0645 FEMA-REP-1 Rev 11)

11. How is this demonstrated? For nuclear power facilities, affected populations could range from a few hundred to several hundred thousand individuals. Most state and local health departments attempt to demonstrate this with: –Hand-held radiation survey instruments –Portal monitors (for only beta/gamma monitoring) are used by only a handful of state agencies (the DOE has 13 deployable with the FRMAC assets) –Alpha portal monitors have limited capabilities and are not easily transportable For nuclear power facilities, affected populations could range from a few hundred to several hundred thousand individuals. Most state and local health departments attempt to demonstrate this with: –Hand-held radiation survey instruments –Portal monitors (for only beta/gamma monitoring) are used by only a handful of state agencies (the DOE has 13 deployable with the FRMAC assets) –Alpha portal monitors have limited capabilities and are not easily transportable External only

12. National Response Framework Nuclear/Radiological Incident Annex Decontamination/Population Monitoring are: “the responsibility of State, local, and tribal governments.” Decontamination/Population Monitoring are: “the responsibility of State, local, and tribal governments.”

13. HHS, through ESF #8 and in consultation with the coordinating agency, coordinates Federal support for external monitoring of people and decontamination. –Department of Energy responsible for equipment and personnel HHS, through ESF #8 and in consultation with the coordinating agency, coordinates Federal support for external monitoring of people and decontamination. –Department of Energy responsible for equipment and personnel National Response Framework Nuclear/Radiological Incident Annex

14. HHS assists and supports State, local, and tribal governments in performing monitoring for internal contamination and administering available pharmaceuticals for internal decontamination, as deemed necessary by State health officials. National Response Framework Nuclear/Radiological Incident Annex

15. HHS assists local and State health departments in establishing a registry of potentially exposed individuals, performing dose reconstruction, and conducting long- term monitoring of this population for potential long-term health effects. National Response Framework Nuclear/Radiological Incident Annex

16. Current State/Federal Capabilities* External monitoring Internal monitoring Bioassay Biodosimetry External monitoring Internal monitoring Bioassay Biodosimetry Marginal Extremely limited *States with nuclear power plants somewhat better prepared.

17. CDC’s Approach to Nuclear/Radiological Preparedness Determine what State, tribal and local public health agencies need Develop and test products that address those needs Prepare to successfully implement CDC’s responsibilities to support State, tribal and local officials Determine what State, tribal and local public health agencies need Develop and test products that address those needs Prepare to successfully implement CDC’s responsibilities to support State, tribal and local officials

18. CDC Efforts to Date January 2005 – Population Monitoring Roundtable September 2005 – Roundtable Report Posted http://emergency.cdc.gov/radiation March 2006 –Satellite broadcast “Preparing for Radiological Population Monitoring and Decontamination” August 2007 - CDC posted draft population monitoring guidance based on input from a number of sources CDC is currently developing rapid radioanalytical laboratory capacity January 2005 – Population Monitoring Roundtable September 2005 – Roundtable Report Posted http://emergency.cdc.gov/radiation March 2006 –Satellite broadcast “Preparing for Radiological Population Monitoring and Decontamination” August 2007 - CDC posted draft population monitoring guidance based on input from a number of sources CDC is currently developing rapid radioanalytical laboratory capacity

19. Laboratory Analyses Conventional methodology –24-hr urine sample –3-7 days turnaround time –5-40 samples/day/lab Improved methodology (for population screening) –1-50 ml “spot” sample –4-36 hours turnaround time (multiple radionuclides) –100-500+ samples/day/lab Field screening and prioritization important Increase number of public health laboratories capable of doing such analyses Conventional methodology –24-hr urine sample –3-7 days turnaround time –5-40 samples/day/lab Improved methodology (for population screening) –1-50 ml “spot” sample –4-36 hours turnaround time (multiple radionuclides) –100-500+ samples/day/lab Field screening and prioritization important Increase number of public health laboratories capable of doing such analyses

20. Radiation Instruments in Hospitals To screen patients for internal contamination –Thyroid Scanners Feasible and practical –Gamma Cameras Not for large numbers To screen patients for internal contamination –Thyroid Scanners Feasible and practical –Gamma Cameras Not for large numbers An Evaluation of Hospital Radiation Detectors for Use in Screening Potentially Contaminated Individuals http://emergency.cdc.gov/radiation

21. Target audience: –State and local public health and emergency preparedness personnel Focus –Incidents involving mass casualties Scope –Assumes local infrastructure is intact –Principles apply to all radiation incidents Target audience: –State and local public health and emergency preparedness personnel Focus –Incidents involving mass casualties Scope –Assumes local infrastructure is intact –Principles apply to all radiation incidents CDC Guidance

22. Purpose State/local emergency response and public health authorities can use this Guide to: –Evaluate their emergency response plans –Identify/prioritize staffing needs, training requirements, and necessary material assets. –Further develop mutual assistance programs –Be better prepared to prioritize allocation of existing resources in actual response State/local emergency response and public health authorities can use this Guide to: –Evaluate their emergency response plans –Identify/prioritize staffing needs, training requirements, and necessary material assets. –Further develop mutual assistance programs –Be better prepared to prioritize allocation of existing resources in actual response

23. Guiding Principles The first priority is to save lives: respond to and treat the injured first. Contamination with radioactive materials is not immediately life-threatening. Initial population monitoring activities should focus on preventing acute radiation health effects. –Cross contamination issues are a secondary concern The first priority is to save lives: respond to and treat the injured first. Contamination with radioactive materials is not immediately life-threatening. Initial population monitoring activities should focus on preventing acute radiation health effects. –Cross contamination issues are a secondary concern

24. Guiding Principles (CONT.) Scalability and flexibility are an important part of the planning process. The State radiation control program is a key resource for implementing the plans outlined in this guide. –Establish relationships with other radiation experts/resources in the community (hospitals, universities, etc.) Scalability and flexibility are an important part of the planning process. The State radiation control program is a key resource for implementing the plans outlined in this guide. –Establish relationships with other radiation experts/resources in the community (hospitals, universities, etc.)

25. Current Status Population Monitoring Planner Guide available from: http://emergency.cdc.gov/radiation Draft for comment Your feedback would be appreciated!! Population Monitoring Planner Guide available from: http://emergency.cdc.gov/radiation Draft for comment Your feedback would be appreciated!!

26. Community Reception Centers Local response strategy for conducting population Monitoring Multi-agency effort, public health lead Staffed by government officials and organized volunteers Opened 24-48 hours post event Located outside of “hot zone” Local response strategy for conducting population Monitoring Multi-agency effort, public health lead Staffed by government officials and organized volunteers Opened 24-48 hours post event Located outside of “hot zone”

27. Community Reception Centers Services include: –Screening for radioactive contamination –Assistance with decontamination –Limited medical care Prioritize people for further care –Ease burden on hospitals –Manage scarce medical resources Comparable to –Neighborhood Emergency Help Centers (NEHC) or –Point of Dispensing (POD) Services include: –Screening for radioactive contamination –Assistance with decontamination –Limited medical care Prioritize people for further care –Ease burden on hospitals –Manage scarce medical resources Comparable to –Neighborhood Emergency Help Centers (NEHC) or –Point of Dispensing (POD)

28. Community Reception Center Process Flow 6 Main Process Areas –Initial Sorting –Emergency Medical Care or Transfer –Survey and Monitoring –Wash Station –Registration and Dose/Medical Assessment –Discharge

29. CRC Process Flow Process can be adjusted to meet existing capabilities –Instrumentation –Personnel There is an “express” lane for people who have cleaned at home. There is an additional module for a “pet-friendly” reception center. Other processes can be added as needed or as possible –e.g., relocation services

30. Work in Progress CRC-STEP –Community Reception Center Simulation Tool for Evaluation and Planning –Excel-based interface for modeling staffing and equipment resources and evaluating throughput. RealOpt-CRC –Optimization tool for maximizing throughput Both decision tools are easy to use User Manuals for both along with short tutorial video on the web will be prepared. CRC-STEP –Community Reception Center Simulation Tool for Evaluation and Planning –Excel-based interface for modeling staffing and equipment resources and evaluating throughput. RealOpt-CRC –Optimization tool for maximizing throughput Both decision tools are easy to use User Manuals for both along with short tutorial video on the web will be prepared.

31. CRC-STEP Simulation Tool for Evaluation and Planning Excel Interface Customizable for Basic and Advanced Users Runtime Animation

32. RealOpt CRC Optimization Software Free, no runtime license required.

33. Work Just Begun Web-based training tool on CRC operations with detailed accompanying documentation and resources

34. Challenge: Adequate staffing for CRC Motivate the country’s large health physics, medical physics, and nuclear medicine community to enlist in a locally-sponsored volunteer registry. CDC is leading a nationwide effort to organize radiation professional volunteers into existing health volunteer registries. Motivate the country’s large health physics, medical physics, and nuclear medicine community to enlist in a locally-sponsored volunteer registry. CDC is leading a nationwide effort to organize radiation professional volunteers into existing health volunteer registries.

35. Radiation Response Volunteer Roundtable February 10-11, 2009, Atlanta, GA Invitees included representatives from: –ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals) –MRC (Medical Reserve Corps) –Professional societies: HPS, NRRPT, AAPM, SNM, ASTRO –CRCPD –Several state health and EM organizations involved in radiation volunteer registries Attendees developed an action plan for establishing roles and training requirements for radiation protection volunteers who could be used for population monitoring for large-scale events in the United States. Invitees included representatives from: –ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals) –MRC (Medical Reserve Corps) –Professional societies: HPS, NRRPT, AAPM, SNM, ASTRO –CRCPD –Several state health and EM organizations involved in radiation volunteer registries Attendees developed an action plan for establishing roles and training requirements for radiation protection volunteers who could be used for population monitoring for large-scale events in the United States.

36. Summary “All emergencies are local” Future terrorist events cannot be dismissed These events may involve radiological components Population monitoring will be a key component in the public health response to any such event “All emergencies are local” Future terrorist events cannot be dismissed These events may involve radiological components Population monitoring will be a key component in the public health response to any such event

37. Radiation Studies Branch, CDC rsb@cdc.gov (770) 488-3800 Charles W. Miller 770-488-3725 cym3@cdc.gov Radiation Studies Branch, CDC rsb@cdc.gov (770) 488-3800 Charles W. Miller 770-488-3725 cym3@cdc.gov THANK YOU http://emergency.cdc.gov/radiation