1. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES How Published Evidence Informed Risk Communication in the Field Pertti (Bert) J. Hakkinen, Ph.D. Senior Toxicologist, and Toxicology and Environmental Health Science Advisor Deepwater Horizon Panel Monday, June 20, 2011 2:45 PM - 4:45 PM

2. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Disclaimer Goals of Presentation Introduction to NLM Overview of NLM’s role in providing resources to decision-makers and responders Description and impact of Wireless Information System for Emergency Responders (WISER) http://wiser.nlm.nih.gov/ http://wiser.nlm.nih.gov/ Additional relevant NLM resources Relevant information from my non-NLM experiences 2

3. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 3 U.S. National Library of Medicine (NLM) NLM’s Mission: Collect, organize, and disseminate health- related information. World’s largest biomedical library Services: PubMed, MedlinePlus and many others Research and Development Biomedical informatics and communications Relatively new focus (within Specialized Information Services): Disaster information

4. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 4 http://www.nlm.nih.gov/

5. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 5 http://sis.nlm.nih.govhttp://sis.nlm.nih.gov/ The Specialized Information Services Division (SIS) of the NLM is responsible for information resources and services in:  Toxicology  Environmental health  Chemistry  HIV/AIDS, and  Specialized topics in minority and other special populations health  Disaster information

6. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Need a central government agency that specializes in providing information for disaster preparedness & response & research. Experts in information management. Long history of programs, partnerships for providing information for disaster preparedness & response. Why have a Disaster Information Management Research Center at the NLM ? 6

7. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES To provide access to authoritative disaster health information to the U.S & world at all stages of disaster preparation, response, mitigation and recovery 7

8. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES  Librarians and other information professionals  Public health workers  Researchers  Emergency managers  First responders  Public and others 8 Target Audiences

9. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 9 http://sis.nlm.nih.gov/dimrc.html

10. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 10 http://disaster.nlm.nih.gov/

11. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 11 Disaster and Emergency Response Tools  Wireless Information System for Emergency Responders (WISER)  Radiation Emergency Medical Management (REMM)  Chemical Hazards Emergency Medical Management (CHEMM)

12. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Wireless Information System for Emergency Responders (WISER) http://wiser.nlm.nih.gov/ 12

13. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES WISER  Easy to use, intuitive  Information tailored to the specific needs and roles of emergency responders  Reliable, complete, and trustworthy information  Focus on unknown substance identification capabilities  Stand-alone capability with enhanced connected (wireless) capabilities  Cross-platform, multi-device architecture http://wiser.nlm.nih.gov 13

14. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Who Uses WISER? First Responders/ Fire Fighters HazMat EMS/Paramedics ER personnel 14

15. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 15  Data on 400+ chemicals, 20+ radiologic agents, and CDC Category A biologic agents  Unknown substance identification  Tools and reference materials  Triage algorithms, ERG 2008 (ERG 2012 will be added when available), WMD Response Guidebook  Radiation procedure docs, Dose Estimator, Unit Converter What’s in WISER

16. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES WISER Platforms – A Little History Palm OS iPhone Windows Mobile WebWISER Blackberry Android Coming soon! Windows 16

17. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES What information sources are used in WISER? Hazardous Substances Data Bank (HSDB)Hazardous Substances Data Bank (HSDB) WMD Response Guidebook CIDRAP 17

18. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES WISER Basics Either you know what you’re dealing with… … or you don’t! 18

19. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Next Steps  WISER for Android  iOS universal support (iPad support)  Help Identify and Tools for iPhone, Android  Protective Distance for iPhone, Android, WebWISER 19

20. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 20 http://wiser.nlm.nih.gov Get WISER!

21. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 21

22. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Additional Relevant NLM Resources 22

23. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 23 Crude oil and dispersant records were added to the Hazardous Substances Data Bank (HSDB). http://toxnet.nlm.nih.gov/cgi- bin/sis/htmlgen?HSDBhttp://toxnet.nlm.nih.gov/cgi- bin/sis/htmlgen?HSDB “In response to the 2010 Deep Water Horizon oil spill, the HSDB development team and the HSDB Scientific Review Panel (SRP) compiled and reviewed data for crude oil, Corexit 9500, and Corexit 9527 records.” HSDB records include data on human health effects, environmental fate and exposure information, etc. NLM-TOX-ENVIRO-HEALTH-L@LIST.NIH.GOV August 30, 2010

24. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 24 http://www.nlm.nih.gov/medlineplus/oilspills.html

25. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 25

26. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 26

27. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 27

28. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 28

29. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 29 http://disaster.nlm.nih.gov/dimrc/oilspills.html

30. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 30 Featured Sites Overviews Health Information Coping with Disasters and Stress Occupational Health Information Crude Oil Dispersants Seafood and Fisheries Contamination Response and Recovery Gulf State Agencies Involved in Prevention, Response, and Recovery Oil Spills and Wildlife Social Media Sites: Gulf Oil Spill Multi-language Resources Disclaimer

31. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 31 http://sis.nlm.nih.gov/enviro/envirohealthlinkscriteria.html

32. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 32 Purpose Authority, Credibility, and Affiliation

33. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 33 Content, Coverage, and Currency Point of View

34. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 34 Intended Audience Access, Navigation, and Availability Language Featured Sites

35. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 35 How to Stay Informed

36. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 36 How to Stay Informed

37. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 37 REFERENCES NLM “In Focus” eNewsletter. NLM Disaster-Response Tools: Helping Emergency Responders. September 30, 2010. http://infocus.nlm.nih.gov/2010/09/nlm-disaster-response- tools-he.html http://infocus.nlm.nih.gov/2010/09/nlm-disaster-response- tools-he.html Hochstein C, Arnesen S, Goshorn J, Szczur M. Selected resources for emergency and disaster preparedness and response from the United States National Library of Medicine. Med Ref Serv Q. 27(1): 1-20 (2008). http://www.ncbi.nlm.nih.gov/pubmed/18689200 http://www.ncbi.nlm.nih.gov/pubmed/18689200

38. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Relevant Information From My Non-NLM Experiences 38

39. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 39 Nancy Neil, Paul Slovic, and P.J. (Bert) Hakkinen, 1993. Mapping Consumer Perceptions of Risk. Chemical Manufacturers Association. Sample Size: 750 subjects Method: 47 items judged by respondents on each of 15 evaluative scales, from large-scale multitopic study www.epa.gov/pesticides/regulating/labels/pdf/cliphase1-rpt.pdf

40. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 40 http://www.ncbi.nlm.nih.gov/pubmed/15292907 Free full text: http://www.nature.com/jes/journal/v14/n7/full/7500392a.html

41. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 41 Hakkinen, P.J. 1993. Commentary about intuitive toxicology: expert and lay judgments of chemical risks. Comments on Toxicology 4: 505-509. http://www.sciencedirect.com/science/article/pii/B0123694000100067

42. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 42 Noteworthy findings from studies of intuitive toxicology in the United States, Canada, and the United Kingdom include: The public: More likely to think that chemicals pose greater risks. Finds it difficult to understand the concept of dose–response relationships. Much more likely to think the results of animal carcinogenicity studies can be applied to humans. Toxicologists: Much disagreement about how to interpret various results. Technical judgments were associated with factors such as place of employment, gender, and age… “…the results also suggest that disagreement among experts, especially as perceived by the news media and the public, can play a key role in controversies over chemical risks.”

43. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Introduction to NLM Overview of the National Library of Medicine’s role in providing resources to decision-makers and responders Description and impact of Wireless Information System for Emergency Responders (WISER) http://wiser.nlm.nih.gov/ http://wiser.nlm.nih.gov/ Additional relevant NLM resources Relevant information from my non-NLM experiences 43 Recap

44. National Library of Medicine NATIONAL INSTITUTES OF HEALTH ◊ U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Comments? Suggestions? Pertti (Bert) J. Hakkinen, Ph.D. National Library of Medicine, National Institutes of Health pertti.hakkinen@nih.gov 44