1. Public Health and Healthcare Issues

2. Public Health and Healthcare

3. Mass Casualty Events Produce large number of patients quickly Surge of patients with severe and minor injuries can rapidly stress the healthcare system and first receivers The majority of injured self report to healthcare facilities Injured report to the closest hospitals to the event

4. Radiation Mass Surge Event Radiation further complicates response and adds additional stress to a stressful situation Radiation raises the fear of contamination in staff who have little understanding of radiation Radiation increases the number of worried well wanting medical evaluation and monitoring

5. Perspective on Mass Surge It is estimated that 10% of the total population will want to be screened for radioactivity exposure Psychological trauma is the driving force

6. Fukushima, Japan 2011 200,000 of a population of 2 million people were scanned and evaluated for contamination Fear of contamination Fear of health consequences

7. Goiania, Brazil 1987 249 people found significantly contaminated 112,000 were evaluated and screened

8. Tokyo Sarin Attack Saint Lukes International Hospital 27% of staff contaminated 526 victims Over 5000 evaluated Majority psychological

10. CDC Guiding Principles First priority is to save lives and treat the injured first Contamination with radioactive materials is not immediately-life treating Initial population monitoring activities should focus on preventing acute radiation health effects Scalability and flexibility are an important part of the planning process

11. CDC Guiding Principles Continued Fear of radiation is high, higher than with other agents of terrorism Radiological decontamination differs from those for chemical agents Law enforcement agencies will be involved in response to a radiological terrorism event

12. Roles and Responsibilities of Public Health CDC lists 15 responsibilities for federal, state and local Public Health As a general rule, during the initial stages of the incident local and state officials should be prepared to handle the crisis without federal assistance (CDC Population monitoring in Radiation Emergencies)

13. Roles and Responsibilities Protecting the publics health Monitoring workers health and safety Ensuring safe shelters for the population Ensuring the safety of food and water Coordinating sampling and laboratory analysis of bio and environmental samples Conducting field investigations Monitoring people who may have been contaminated with radioactive materials or exposed to radiation Conducting or assisting in decontamination Recommending management protocols for affected populations or individuals

14. Hospital Mass Surge Issues Patients arrive before the event is recognized as radiological by first responders Contamination of the ER occurs before the event is recognized as radiological Staff ill prepared to deal with radiological effected patients Correct staff not present Surge of worried well stresses facilitys ability to care for the seriously injured

15. Hospital Mass Surge Issues Hospital staff lack the ability to communicate with the massive crowds of people Staff fearful of radiation and the large crowds seeking care Limited decon capabilities and limited ability to scan patients for radiation Traffic management issues, abandoned cars, contaminated cars

16. The Role of Community Reception Centers To divert people with minor or no injuries away from the hospital for scanning and counseling To decrease the impact of surge on patient care and hospital staff To identify people who may need immediate assistance----decontamination, medical attention, psychosocial needs

17. Objectives of Monitoring Identify individuals whose health is in immediate danger Identify people who may need medical treatment for contamination or exposure To try to minimize future health for long term health monitoring Register potentially affected populations for long term health monitoring

18. Security Needs Traffic management at hospitals and Reception Centers Security of facilities inside and on grounds Risk of facility contamination Threatening environment to staff responding to the incident Risk as a secondary target

19. Why Security for Hospitals Represent critical infrastructure in their community Symbols of safety and security for a community being affected by a mass casualty event To ensure safety of staff while providing care to the surge of patients To facilitate traffic flow, campus lock down, facility lock down

20. Why Reception Center Security Traffic management Crowd containment and management Safety of staff and patients Secondary target Limit access to the facility and grounds Security of personal belongings

21. Planning and Communication