The Role of Public Health in a

The Role of Public Health in a
Nuclear or Radiological Terrorist Incident

February 3, 2005
Script

CDC0203.05

>>> THIS DOES NOT CONSTITUTE AN

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PREVENTION.

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>>> HELLO AND WELCOME TO "THE

ROLE OF PUBLIC HEALTH

IN A NUCLEAR OR RADIOLOGICAL

TERRORIST INCIDENT."

HELLO, EVERYONE.

I'M KYSA DANIELS, YOUR MODERATOR

FOR THIS PROGRAM WHICH IS

BEING BROADCAST FROM THE CENTERS

FOR DISEASE CONTROL AND

PREVENTION IN ATLANTA, GEORGIA.

THIS PROGRAM IS SPONSORED BY CDC

AND THE PUBLIC HEALTH TRAINING

NETWORK.

THE GOALS OF THIS PROGRAM ARE

TO PROVIDE THE PUBLIC HEALTH

WORKFORCE WITH INFORMATION

RELATED TO RADIATION,

INCLUDING THE DIFFERENCE BETWEEN

IONIZING AND NON-IONIZING

RADIATION,

TYPES AND PENETRATING ABILITIES

OF RADIATION, POSSIBLE NUCLEAR

AND RADIOLOGICAL THREATS,

RADIOPROTECTIVE MEASURES,

CONTAMINATION WITH RADIOACTIVE

MATERIALS VERSUS EXPOSURE

TO RADIATION AND PROTECTIVE

ACTION GUIDES.

ANOTHER GOAL IS TO PROVIDE

THE PUBLIC HEALTH WORKFORCE

WITH THE FOLLOWING INFORMATION

RELATED TO THE ROLE OF PUBLIC

HEALTH IN A NUCLEAR OR

RADIOLOGICAL INCIDENT --

BASIC ROLES AND RESPONSIBILITIES

OF PUBLIC HEALTH, INITIAL

AND LONG-TERM RESPONSE ROLES,

THE NATIONAL RESPONSE PLAN, ROLE

OF HEALTH AND HUMAN

SERVICES, HHS, AND THE ROLE OF

CDC.

AT THE COMPLETION OF THIS

BROADCAST, PARTICIPANTS WILL BE

ABLE TO, NUMBER ONE, EXPLAIN THE

BASIC

PRINCIPLES OF RADIATION,

DESCRIBE PROTECTIVE ACTION

GUIDES FOR A RADIOLOGICAL

INCIDENTS.

DESCRIBE THE RESPONSIBILITIES OF

CDC AND IN A RADIOLOGICAL

INCIDENT UNDER THE NATIONAL

RESPONSE PLAN.

EXPLAIN THE ROLES OF CDC

IN A RADIOLOGICAL INCIDENT,

DESCRIBE THE INITIAL RESPONSE

ROLES OF PUBLIC HEALTH

IN A RADIOLOGICAL INCIDENT,

AND DESCRIBE LONG-TERM RESPONSE

ROLES OF PUBLIC HEALTH

IN A RADIOLOGICAL INCIDENT.

NOW, AS A VIEWER, YOU MAY

PARTICIPATE

IN THE LEARNING EXPERIENCE

BY CALLING OR FAXING

IN THEIR QUESTIONS

FOR OUR PANELISTS.

WE'LL ANSWER YOUR QUESTIONS

FOLLOWING THE PRESENTATION.

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800-793-8598.

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VIEWER, YOU CAN CALL --

404-639-0180.

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OR COMMENTS TO US AT --

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404-639-0181.

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THE INTERNATIONAL TTY NUMBER IS

404-639-0182.

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PROGRAM IS AVAILABLE

AT 800-728-8232 ONLY DURING THIS

PROGRAM.

INTERNATIONAL CALLERS MAY DIAL

404-639-1289.

IF YOU WOULD LIKE TO RECEIVE

CONTINUING EDUCATION CREDIT

YOU MUST REGISTER

WITH THE CDC/ATSDR TRAINING

AND CONTINUING EDUCATION ONLINE

SYSTEM.

YOU CAN ACCESS THAT INFORMATION

AT --

WWW.PHPPO.CDC.GOV/PHTN

ONLINE.

ONCE YOU HAVE REGISTERED,

YOU MUST COMPLETE AN EVALUATION

FOR THE ACTIVITY.

AND NOW THAT WE'VE GOTTEN SOME

OF OUR HOUSEKEEPING OUT OF THE

WAY, LET'S SET THE STAGE FOR OUR

UPCOMING DISCUSSION BY VIEWING

ONE POSSIBLE TERRORIST SCENARIO.

>>> IT'S A BEAUTIFUL, CHILLY

FALL DAY AT YOUR LOCAL

UNIVERSITY, A GREAT DAY

FOR FOOTBALL.

THE SUN IS SHINING AS A CAPACITY

CROWD CHEERS ON THE LOCAL TEAM,

COMPETING FOR A CONFERENCE

PLAYOFF SPOT AGAINST

THEIR BIGGEST RIVAL.

JUST AS THE HOME TEAM MAKES

A FIRST DOWN ON THE 30-YARD

LINE, THE FANS GO WILD.

THERE'S A HORRIFIC EXPLOSION

FROM THE OTHER END

OF THE STADIUM.

A SPLIT SECOND OF SILENCE

FOLLOWS BEFORE PANICKED SCREAMS

ARE HEARD.

PEOPLE BEGIN JAMMING THE EXITS

TO ESCAPE THE SCENE WHILE OTHERS

ARE TRAPPED IN DEBRIS BENEATH

THE STADIUM.

WITHIN MINUTES, SIRENS ARE HEARD

AS FIRST RESPONDERS BEGIN RACING

TOWARDS THE STADIUM.

POLICE AND FIRE VEHICLES AS WELL

AS AMBULANCES FILL THE ROADWAYS

OUTSIDE THE STADIUM AS THOUSANDS

OF PEOPLE COVERED IN DUST

AND DEBRIS, FLEE THE SCENE.

FIRST RESPONDERS ARRIVE

AT THE STADIUM AND CHECK

FOR BIOLOGICAL, CHEMICAL,

AND RADIOLOGICAL AGENTS,

BUT FIND NONE AND CONTINUE

TO WORK IN THE AREA.

WITHIN A FEW HOURS, HAZMAT TEAMS

ARRIVE AND SURVEY THE SCENE

USING MORE SOPHISTICATED

RADIOLOGICAL INSTRUMENTS

AND DISCOVER THAT A SIGNIFICANT

AMOUNT OF RADIOLOGICAL MATERIAL

IS PRESENT.

THE EXPLOSION AT THE STADIUM WAS

A DIRTY BOMB.

THOSE WHO LEFT THE SCENE MAY

HAVE BEEN CONTAMINATED

WITH RADIOACTIVE MATERIAL

AND HAVE, BY NOW, SPREAD THAT

MATERIAL ALL OVER THE CITY

AND POSSIBLY THE COUNTRY.

WHAT DO YOU DO?

>> THAT'S A POIGNANT QUESTION

AND HERE TO HELP US DEFINE OUR

ROLES IN SUCH A SCENARIO ARE --

JAMES M. SMITH, PHD,

A BIOPHYSICIST AND ASSOCIATE

DIRECTOR FOR RADIATION

WITH THE DIVISION

OF ENVIRONMENTAL HAZARDS

AND HEALTH EFFECTS, NATIONAL

CENTER FOR ENVIRONMENTAL HEALTH,

CENTERS FOR DISEASE CONTROL

AND PREVENTION.

CHARLES W. MILLER, Ph.D., A

HEALTH PHYSICIST AND CHIEF

OF THE RADIATION STUDIES BRANCH,

DIVISION OF ENVIRONMENTAL

HAZARDS AND HEALTH EFFECTS,

NATIONAL CENTER FOR

ENVIRONMENTAL HEALTH, CENTERS

FOR DISEASE CONTROL

AND PREVENTION.

AND DEBRA McBAUGH, CHP,

FROM THE WASHINGTON STATE

DEPARTMENT OF HEALTH.

A HEALTH PHYSICIST AND HEAD

OF THE ENVIRONMENTAL RADIATION

SECTION, DEPARTMENT OF HEALTH,

WASHINGTON.

WELCOME TO ALL OFY, AND

DR. SMITH, WE'LL GET STARTED

WITH YOU FIRST.

>> THANK YOU, KYSA.

>>> FIRST, I THINK IT'S

IMPORTANT FOR US TO DEFINE WHAT

WE MEAN WHEN WE SAY "RADIATION."

THIS TERM CAN BE ASSOCIATED

WITH NUCLEAR SOURCES, FOR

EXAMPLE, RADIO AND TELEVISION

SIGNALS, ENERGY FROM THE SUN,

LIGHT, HEAT AND MICROWAVES.

IF WE LOOK AT THE

ELECTROMAGNETIC SPECTRUM, WE SEE

THAT RADIATION GENERALLY CAN BE

DIVIDED INTO TWO BROAD

CATEGORIES.

THE HIGHER ENERGY RADIATION

ON THE RIGHT SIDE

OF THE SPECTRUM HAS SUFFICIENT

ENERGY TO EJECT ELECTRONS

FROM ATOMS AND MOLECULES WHEN IT

INTERACTS WITH MATTER.

NOW, THIS REACTION CREATES

HIGHLY REACTIVE ATOMIC AND

MOLECULAR SPECIES, AND

WE REFER TO THIS PROCESS

AS IONIZATION, AND THEREFORE

WE CALL THIS IONIZING RADIATION,

AND NOW ON THE LOWER ENERGY

SECTION, ON THE LOWER LEFT,

WE CALL NON-IONIZING RADIATION.

THIS INCLUDES ELECTRICAL POWER,

MICROWAVE ENERGY, LIGHT,

AND RADIO AND TELEVISION

SIGNALS.

WHAT WE ARE DISCUSSING TODAY

INVOLVES IONIZING EXCLUSIVELY,

THE HIGHER PART OF THE SPECTRUM.

IN ADDITION TO X-RAYS AND GAMMA

RADIATION, WHICH ARE PART

OF THE ELECTROMAGNETIC SPECTRUM,

THERE ARE THREE OTHER COMMON

TYPES OF IONIZING RADIATION

EMITTED DURING RADIOACTIVE DECAY

OR NUCLEAR FISSION.

THESE ARE ALPHA AND BETA

PARTICLES AS WELL AS NEUTRONS.

EACH TYPE OF IONIZING RADIATION

HAS A DIFFERENT ABILITY

TO INTERACT WITH AND PENETRATE

MATTER.

THESE PROPERTIES CAN

SIGNIFICANTLY INFLUENCE NOT ONLY

THE POTENTIAL HEALTH EFFECTS

OF EACH TYPE OF RADIATION,

BUT ALSO THE ACTION WE SHOULD

TAKE TO PROTECT

OURSELVES AND OTHERS.

ALPHA PARTICLES MAY BE EJECTED

FROM THE NUCLEUS OF AN ATOM

DURING RADIOACTIVE DECAY.

THEY ARE RELATIVELY HEAVY

AND TRAVEL ONLY ABOUT AN INCH IN

AIR.

THEY BE ALSO BE EASILY SHIELDED

FROM A SINGLE SHEET OF PAPER,

FOR EXAMPLE, AND CANNOT

PENETRATE

THE OUTER DEAD LAYER OF SKIN.

SO, THEY POSE NO DANGER WHEN

THEIR SOURCE IS OUTSIDE

THE HUMAN BODY.

BETA PARTICLES ARE ESSENTIALLY

ELECTRONS EMITTED

FROM THE NUCLEUS OF

A RADIOACTIVE ATOM.

THEY ARE LIGHTER THAN ALPHA

PARTICLES AND CAN TRAVEL FARTHER

IN AIR, UP TO SEVERAL YARDS.

VERY ENERGETIC BETA PARTICLES

CAN PENETRATE UP TO ONE HALF

OF AN INCH THROUGH SKIN

AND INTO THE BODY.

THEY CAN BE SHIELDED WITH LESS

THAN AN INCH OF MATERIAL SUCH

AS PLASTIC.

IN THE CASE OF LOWER ENERGY BETA

PARTICLES, THE OUTER LAYER

OF CLOTHING CAN ACT

AS AN EFFECTIVE SHIELD.

GAMMA RAYS, THE MOST ENERGETIC

PART OF AN ELECTRONIC SPECTRUM

CAN BE EMITTED

FROM THE NUCLEUS OF AN ATOM

DURING RADIOACTIVE DECAY.

THEY ARE ABLE TO TRAVEL TENS

OF YARDS OR MORE IN AIR

AND EASILY PENETRATE

THE HUMAN BODY.

SHIELDING THIS PENETRATING

TYPE OF IONIZING RADIATION

REQUIRES THICK, DENSE MATERIAL,

SUCH AS SEVERAL INCHES OF LEAD

OR CONCRETE.

NEUTRONS CAN BE RELEASED

FROM THE NUCLEUS OF AN ATOM

DURING A FISSION REACTION, SUCH

AS WITHIN A NUCLEAR REACTOR

OR UPON DETONATION OF A NUCLEAR

WEAPON.

NEUTRONS, LIKE GAMMA RAYS, ARE

VERY PENETRATING, AND SEVERAL

FEET OF CONCRETE IS NEEDED TO

SHIELD AGAINST THEM.

WHEN WE SPEAK OF RADIOACTIVE

MATERIALS, WE MEAN THOSE

SUBSTANCES THAT CONTAIN NUCLIDES

OR ISOTOPES THAT SPONTANEOUSLY

EMIT IONIZING RADIATION

THROUGH RADIOACTIVE DECAY.

SOME COMMON EXAMPLES INCLUDE

THOSE THAT ARE NATURALLY

OCCURRING, SUCH AS CARBON-14,

POTASSIUM-40, AND URANIUM-238,

AND THOSE MANUFACTURED FOR USE

IN MEDICINE, SUCH AS

TECHNETIUM-99M, IODINE-131,

AND THALLIUM-201 AND THOSE

FROM NUCLEAR WEAPONS FALLOUT,

SUCH AS COBALT-60, CESIUM-137,

AND PLUTONIUM-239.

ONE OF THE MOST CONFUSING

ASPECTS OF RADIATION IS

THE NOTION OF SOMEONE BEING

CONTAMINATED VERSUS BEING

EXPOSED.

SIMPLY PUT, CONTAMINATION REFERS

TO HAVING RADIOACTIVE MATERIAL

ON OR INSIDE OF THE BODY.

EXPOSURE, ON THE OTHER HAND,

REFERS TO RADIATION

FROM RADIOACTIVE MATERIAL

OR OTHER SOURCES

ACTUALLY PENETRATING THE BODY.

LET'S LOOK AT THESE CONCEPTS

MORE CLOSELY.

HAD WE ARE NEAR A SOURCE OF

RADIATION, SUCH AS RADIOACTIVE

MATERIAL, WE CAN BE EXPOSED

TO THE RADIATION EMITTED BY THIS

SOURCE; HOWEVER, HE OR SHE DOES

NOT BECOME CONTAMINATED.

ONE WAY TO THINK ABOUT EXPOSURE

IS TO THINK ABOUT X-RAYS.

WHEN A PERSON HAS A CHEST X-RAY,

HE OR SHE IS EXPOSED

TO RADIATION, BUT DOES NOT

BECOME CONTAMINATED WITH

RADIOACTIVE MATERIAL.

WE CAN REDUCE OUR EXPOSURE TO

RADIATION IF WE ARE SHIELDED IN

SOME WAY.

FOR EXAMPLE, BY STANDING BEHIND

A CONCRETE WALL OR KEEPING THE

RADIOACTIVE SOURCE INSIDE OF A

LEAD CONTAINER.

TO BECOME CONTAMINATED,

RADIOACTIVE MATERIAL MUST GET ON

THE SKIN OR CLOTHING OR INSIDE

OF THE BODY.

FOR EXAMPLE, DOCTOR A DIRTY BOMB

THAT IS LACED WITH RADIOACTIVE

MATERIAL.

WHEN THE DEVICE IS DETONATED,

PEOPLE CAN NOT ONLY BE INJURED

BY THE BLAST, BUT BECOME

CONTAMINATED.

EXTERNAL CONTAMINATION REFERS TO

RADIOACTIVE MATERIAL ON THE

OUTSIDE OF THE BODY.

WHEN A PERSON BECOMES EXTERNALLY

CONTAMINATED, SIMPLY REMOVING

THE CLOTHING CAN REMOVE AS MUCH

AS 90% OF THE CONTAMINATION.

GENTLY WASHING THE SKIN AND THE

HAIR CAN REMOVE MOST OF THAT

WHICH REMAINS.

IF A PERSON INGESTS OR INHALES

RADIOACTIVE MATERIAL, IT CAN

BECOME INCORPORATED

IN THE ORGANS OF THE BODY.

THIS IS CALLED INTERNAL

CONTAMINATION.

WHEN A PERSON IS INTERNALLY

CONTAMINATED, DEPENDING

ON THE TYPE OF RADIOACTIVE

MATERIAL WITH WHICH THEY ARE

CONTAMINATED, CERTAIN

MEDICATIONS CAN BE ADMINISTERED

TO SPEED UP THE RATE AT WHICH

THE MATERIAL IS ELIMINATED FROM

THE BODY.

EXAMPLES OF SUCH MEDICATIONS

INCLUDE PRUSSIAN BLUE AND DTPA.

IN GENERAL, WE MEASURE RADIATION

EXPOSURE IN TERMS OF ABSORBED

DOSE.

THAT IS, THE AMOUNT

OF RADIATION ENERGY ABSORBED

BY AN OBJECT DIVIDED BY THE MASS

OF THE OBJECT.

IN THE U.S., THE UNIT THAT

WE USE IS THE RAD.

HOWEVER, INTERNATIONALLY,

THE UNIT IS THE GRAY.

FORTUNATELY, IT'S EASY TO

CONVERT.

ONE GRAY IS EQUAL TO 100 RADS.

NOW, THE BIOLOGICAL AND HEALTH

EFFECTS FROM RADIATION EXPOSURE

DEPEND DIRECTLY ON THE ABSORBED

DOSE BUT ARE MODIFIED

BY BIOLOGICAL FACTORS

AS WELL AS THE TYPE OF

RADIATION.

WHEN WE CALCULATE

THE BIOLOGICALLY EFFECTIVE

OR SIGNIFICANT DOSE, IT IS

COMMON IN THE U.S. TO USE

THE UNIT OF REM.

INTERNATIONALLY, THE

UNIT SIEVERT IS USED.

AGAIN, AN EASY CONVERSION --

ONE SIEVERT IS EQUAL TO 100 REM.

TO GET A FEEL FOR THIS

MEASUREMENT, NOTE THAT

A CHEST X-RAY IS ABOUT 1/100 OF

A REM, OR 10 MILLIREM.

IT IS IMPORTANT TO POINT OUT

HERE THAT RADIATION IS ALL

AROUND US.

FOR EXAMPLE, WE ARE EXPOSED

DAILY TO RADIATION FROM COSMIC

SOURCES THROUGHOUT THE UNIVERSE,

TO NATURALLY OCCURRING

RADIOACTIVE ISOTOPES

IN OUR BODIES, AND EVEN

THE RADIOACTIVE GAS, RADON,

IN THE AIR WE BREATHE.

EACH YEAR WE ARE EXPOSED

TO ABOUT 1/3 OF A REM FROM ALL

SOURCES COMBINED.

AS YOU CAN SEE FROM THIS GRAPH,

WE RECEIVE MOST OF OUR ANNUAL

DOSE FROM BREATHING RADON,

BUT WE ALSO RECEIVE SOME FROM

MEDICAL EXAMS, SUCH AS

DIAGNOSTIC X-RAYS,

AND FROM RADIOACTIVE NUCLIDES

IN THE SOIL, SUCH

AS THE ISOTOPES OF RADIUM

AND URANIUM.

THE BASIC MECHANISM BY WHICH

RADIATION EXPRESSES BIOLOGICAL

EFFECTS IS THROUGH INTERACTION

WITH THE DNA FOUND IN THE CELLS

OF OUR BODY.

DAMAGE TO DNA CAN RESULT IN CELL

DEATH AND, IF SUFFICIENT NUMBERS

OF CELLS DIE, THE RESULT CAN BE

INJURY TO TISSUE OR ORGANS.

BUT EVEN IF THE CELL SURVIVES

THE DAMAGE, IT CAN STILL BE

TRANSFORMED OR MUTATED

IN SOME WAY.

SO EITHER CELL DEATH OR CELL

TRANSFORMATION CAN LEAD

TO A VARIETY OF POSSIBLE HEALTH

CONSEQUENCES.

WE SHOULD NOTE HERE THAT,

ALTHOUGH WE HAVE LEARNED MUCH

ABOUT THESE MECHANISMS

THROUGH DECADES OF BASIC

RESEARCH, THE COMPLETE PICTURE

OF HOW RADIATION CAUSES

BIOLOGICAL EFFECTS HAS YET

TO EMERGE.

MORE RESEARCH IS NEEDED.

NOW, PEOPLE ARE OFTEN QUITE

CONCERNED ABOUT RADIATION

EXPOSURE, BECAUSE OF THE KNOWN

HEALTH EFFECTS ASSOCIATED WITH

IT.

SOME OF THESE INCLUDE --

DEATH AT VERY HIGH DOSES,

MUTAGENIC EFFECTS, WHICH CAN

LEAD TO GENETIC CHANGES

IN SUBSEQUENT GENERATIONS,

CARCINOGENIC EFFECTS, AND OTHER

BIOLOGICAL EFFECTS, ESPECIALLY

AT HIGH DOSES.

FIRST, LET'S CONSIDER THE EARLY,

ACUTE EFFECTS FROM HIGH DOSES.

NOW, IN THE RANGE OF ABOUT 100

TO 400 REM, MOST PEOPLE EXPOSED

WILL SURVIVE WITH APPROPRIATE

MEDICAL CARE.

THE SYMPTOMS IN THIS DOSE RANGE

INCLUDE NAUSEA AND VOMITING,

FATIGUE, LOSS OF APPETITE,

AND GENERAL MALAISE.

IN THE 400 TO 600 REM RANGE,

ABOUT 50% OF THOSE EXPOSED WILL

DIE.

THE SYMPTOMS INCLUDE ALL

OF THE ABOVE PLUS DIARRHEA,

FEVER, HEMORRHAGE, INFLAMMATION

OF THE MOUTH AND THROAT

AND EMACIATION.

IN GENERAL, THESE SYMPTOMS MAY

BEGIN WITHIN MINUTES TO DAYS

AFTER EXPOSURE AND THE HIGHER

THE DOSE, THE EARLIER

THE SYMPTOMS WILL APPEAR.

AS THE DOSE INCREASES

ABOVE 600 REM, THE PROBABILITY

OF SURVIVAL RAPIDLY DECREASES.

THE CAUSE OF DEATH IN MOST CASES

IS THE DESTRUCTION

OF THE PERSON'S BONE MARROW,

WHICH RESULTS IN INFECTIONS

AND INTERNAL BLEEDING.

IN ADDITION TO ACUTE EFFECTS

FROM DOSES ABOVE 100 REM, THERE

CAN BE ADVERSE HEALTH

CONSEQUENCES THAT OCCUR AT NOT

ONLY LOWER DOSES, BUT ARE

DELAYED FOR YEARS OR DECADES

FOLLOWING EXPOSURE.

THE PRIMARY LATE EFFECT THAT HAS

BEEN IDENTIFIED IS CANCER.

HOWEVER, IT IS IMPORTANT TO NOTE

THAT THE OCCURRENCE

OF A RADIATION-INDUCED CANCER IS

HIGHLY INFLUENCED BY A VARIETY

OF FACTORS, PRIMARILY

THE RADIATION DOSE, BUT ALSO

THE AGE AND GENDER OF THE PERSON

EXPOSED AND THE SPECIFIC ORGANS

IRRADIATED.

SOME EXAMPLES OF THE MORE

RADIOSENSITIVE ORGANS INCLUDE

THE BONE MARROW, THE DIGESTIVE

SYSTEM, WHICH INCLUDES

THE STOMACH AND INTESTINES,

AND THE THYROID GLAND.

ALSO NOTE THAT

THE FEMALE THYROID AND BREAST

ARE MORE SENSITIVE

TO RADIATION-INDUCED CANCER THAN

THOSE OF THE MALE.

AND, IN GENERAL, CHILDREN ARE

MORE SENSITIVE TO CARCINOGENIC

EFFECTS OF RADIATION THAN

ADULTS.

I'LL WRAP UP WITH PRACTICAL

SUGGESTIONS ON REDUCING EXPOSURE

TO RADIATION.

IN THE CASE OF A RADIOLOGICAL

OR NUCLEAR EVENT.

THE EASIEST AND MOST EFFECTIVE

WAY IS THROUGH THE USE OF TIME,

DISTANCE AND SHIELD.

SIMPLY PUT, TO REDUCE

YOUR RADIATION EXPOSURE, DECEASE

THE TIME SPENT NEAR

THE RADIATION SOURCE, INCREASE

THE DISTANCE BETWEEN

YOU AND THE SOURCE -- THAT IS,

GET AS FAR AWAY AS POSSIBLE.

AND FINALLY, PROVIDE AS MUCH

PHYSICAL SHIELDING BETWEEN

YOU AND THE SOURCE AS PRACTICAL.

WITH REGARD TO PHYSICAL

SHIELDING, THE ENVIRONMENTAL

PROTECTION AGENCY'S MANUAL

OF PROTECTIVE ACTION GUIDES

GIVES THESE ESTIMATES

OF THE EFFECTIVENESS

OF A VARIETY OF SHELTERS.

AS YOU CAN SEE, WITHIN A LARGE

BUILDING, WHERE PEOPLE MAY BE

ABLE TO MOVE TO THE CENTER, AWAY

FROM A RADIATION SOURCE LOCATED

OUTSIDE THE BUILDING, PEOPLE CAN

REDUCE THEIR DOSES BY UP TO 80%.

ON THE OTHER HAND, A WOOD FRAME

STRUCTURE IN WHICH PEOPLE ARE

SHELTERED ON THE FIRST FLOOR,

ONLY OFFERS A 10% REDUCTION

IN DOSE.

SO, KYSA, IT IS IMPORTANT

TO REMEMBER THAT ANY REDUCTION

IN EXPOSURE THAT CAN BE

PRACTICALLY ACHIEVED, WHETHER

THROUGH TIME, DISTANCE,

OR SHIELDING, IS THE SAFEST WAY

WE CAN PROTECT AND OTHERS

FROM THE POTENTIAL HARMFUL

EFFECTS OF UNWANTED RADIATION

EXPOSURE.

>> THANK YOU, DR. SMITH,

FOR HELPING US UNDERSTAND SOME

OF THE BASIC CONCEPTS ASSOCIATED

WITH RADIATION.

APPRECIATE YOU.

WE TURN NOW TO

DR. CHARLES W. MILLER, WHO WILL

DISCUSS SOME POTENTIAL TERRORIST

NUCLEAR AND RADIOLOGICAL

SCENARIOS AND THE ROLE OF CDC

IN SUCH AN INCIDENT.

DR. MILLER.

>> THANK YOU, KYSA.

>>> WHEN WE DISCUSS HOW

RADIOACTIVE MATERIAL COULD BE

RELEASED INTO THE ENVIRONMENT

BY TERRORISTS, WE ARE TALKING

ABOUT TWO BASIC CATEGORIES

OF EVENTS --

A RADIOLOGICAL INCIDENT

OR A NUCLEAR INCIDENT.

ALTHOUGH THERE IS SOME

DISAGREEMENT ON THE SEMANTICS,

BASICALLY, A NUCLEAR INCIDENT

INVOLVES A FISSION OR FUSION

REACTION, THAT IS, THE SPLITTING

OR UNITING OF ATOMS, WHEREAS

A RADIOLOGICAL EVENT DOES NOT.

TERRORIST INCIDENTS THAT COULD

BE CONSIDERED RADIOLOGICAL

INCLUDE THE USE OF

A RADIOLOGICAL DISPERSAL DEVICE,

SUCH AS A DIRTY BOMB, IN WHICH

RADIOACTIVE MATERIAL IS SPREAD

OVER AN AREA, CONTAMINATING

PEOPLE AND THE ENVIRONMENT.

IT IS COMMON FOR THE TERMS

"RADIOLOGICAL DISPERSAL DEVICE"

AND "DIRTY BOMB" TO BE USED

TO REFER TO THE SAME THING.

A DIRTY BOMB, OF COURSE, IS

A CONVENTIONAL EXPLOSIVE DEVICE

THAT IS LACED WITH RADIOACTIVE

MATERIAL.

HOWEVER THERE ARE OTHER WAYS,

BESIDES THE USE OF EXPLOSIVES,

IN WHICH RADIOACTIVE MATERIAL

COULD BE DISPERSED.

ANOTHER RADIOLOGICAL SCENARIO

INVOLVES THE MALICIOUS USE

OF RADIOACTIVE SUBSTANCES, SUCH

AS COVERTLY PLACING A HIGH-ENERGY

RADIOACTIVE SOURCE IN AN AREA

WHERE PEOPLE WOULD BE EXPOSED

TO RADIATION WITHOUT

THEIR KNOWLEDGE.

EXAMPLES OF NUCLEAR INCIDENTS,

ON THE OTHER HAND, INCLUDE

A TARGETED ATTACK ON A NUCLEAR

FAST.

A NUCLEAR WEAPON,

OR AN IMPROVISED NUCLEAR DEVICE,

SOMETIMES CALLED AN IND.

NOW, NUCLEAR FACILITIES ARE

HEAVILY GUARDED AND HAVE MANY

BUILT-IN SAFETY FEATURES.

ALSO, MODERN NUCLEAR WEAPONS ARE

VERY CAREFULLY CONTROLLED,

REDUCING THE ABILITY

OF TERRORISTS TO OBTAIN ONE.

BUT WHAT IS AN IMPROVISED

NUCLEAR DEVICE AND HOW

DESTRUCTIVE COULD SUCH

A DEVICE BE?

WHEN I HEAR THAT SOMETHING IS

IMPROVISED, I OFTEN ASSUME THAT

WE ARE TALKING ABOUT SOMETHING

CRUDE AND NOT VERY EFFICIENT.

IN 1945, THE UNITED STATES

DROPPED TWO ATOMIC BOMBS

ON JAPAN.

THE DEVICE DROPPED ON HIROSHIMA

WAS NICKNAMED "LITTLE BOY."

THIS BOMB RESULTED

IN OVER 120,000 CASUALTIES, BOTH

DEAD AND INJURED, AND WIDESPREAD

PHYSICAL DESTRUCTION.

THE DESIGN OF LITTLE BOY WAS

SO SIMPLE, THAT THIS DESIGN WAS

NEVER TESTED BEFORE THE BOMBING

OF HIROSHIMA.

FROM A PHYSICS AND ENGINEERING

POINT OF VIEW, LITTLE BOY WAS

AN IMPROVISED NUCLEAR DEVICE.

IF TERRORISTS WERE ABLE

TO OBTAIN THE RIGHT RADIOACTIVE

MATERIALS, THEY COULD

POTENTIALLY BUILD A WEAPON

OF THIS MAGNITUDE.

NOW, THE DEPARTMENT OF HOMELAND

SECURITY IS AWARE OF THIS FACT.

IN 2003 RELEASED A REPORT

FROM THE WORKING GROUP

ON RADIOLOGICAL DISPERSAL DEVICE

PREPAREDNESS AND NOTED THAT,

"FOR AN IMPROVISED NUCLEAR

DEVICE, GREATER THAN

100,000 PATIENTS COULD REQUIRE

EVALUATION AND TREATMENT."

HOWEVER, MOST EXPERTS CONSIDER

AN RDD OR OTHER MALICIOUS USE

OF A RADIOACTIVE SOURCE TO BE

A MORE LIKELY SCENARIO.

THIS SCENARIO IS MORE FEASIBLE

BECAUSE OF THE WIDE AVAILABILITY

OF SUCH SOURCES.

CURRENTLY THERE ARE

157,000 LICENSED USERS

OF RADIOACTIVE MATERIALS

IN THE UNITED STATES.

TWO MILLION DEVICES CONTAINING

RADIOACTIVE SOURCES ARE IN USE

AROUND THE COUNTRY.

AND EACH YEAR, AROUND

400 SOURCES ARE LOST OR STOLEN

IN THE U.S.

IN THE UNITED STATES.

MOST OF THESE SOURCES ARE SMALL.

OTHERS, HOWEVER, ARE MUCH LARGER

AND MORE RADIOACTIVE, SUCH

AS SOURCES FOUND IN FOOD

IRRADIATORS ANDRADIOTHERAPY

MACHINES.

FURTHERMORE, MANY RADIOACTIVE

SOURCES THAT ARE PHYSICALLY

SMALL ARE STRONG ENOUGH

TO INJURE PEOPLE IF THE SOURCE

IS NOT PROPERLY SHIELDED.

IN ADDITION TO RADIOACTIVE

SOURCES IN THE UNITED STATES,

THESE TYPES OF SOURCES ARE FOUND

ALL OVER THE WORLD.

IN THE FORMER SOVIET UNION, SOME

SOURCES STILL REMAIN UNACCOUNTED

FOR AND UNSECURED.

THE INTERNATIONAL ATOMIC ENERGY

AGENCY, IAEA, IS WORKING

TO LOCATE AND SECURE AS MANY

OF THESE SOURCES SUCH

AS THEY CAN.

THE PHOTO ON THE LEFT SHOWS

A BATTERED RADIOACTIVE SOURCE

CONTAINER THAT WAS RECOVERED

BY THE IAEA.

THE PHOTO ON THE RIGHT SHOWS

FOUR DEVICES USED TO IRRADIATE

AGRICULTURAL SEEDS. EACH

OF THESE IRRADIATORS, WHICH WERE

WIDELY USED IN THE FORMER

SOVIET UNION, CONTAINED A LARGE

AMOUNT OF RADIOACTIVE

CESIUM-137.

RADIOACTIVE MATERIAL FROM ANY

OF THESE CONTAINERS COULD BE

USED TO BUILD A RADIOLOGICAL

DISPERSAL DEVICE.

NOW, AS I MENTIONED A MOMENT AGO

A RADIOLOGICAL DISPERSAL DEVICE

DOES NOT NECESSARILY NEED TO USE

EXPLOSIVES TO SPREAD RADIOACTIVE

MATERIALS.

FOR EXAMPLE, TERRORISTS COULD

COVERTLY PLANT RADIOACTIVE

SOURCES IN ORDER TO CONTAMINATE

PEOPLE AND THE ENVIRONMENT

OR SUCH MATERIALS COULD SIMPLY

FALL INTO THE WRONG HANDS.

THE MOST NOTABLE INCIDENT

INVOLVING THE RELEASE

OF A RADIOACTIVE SOURCE OCCURRED

IN GOIANIA, BRAZIL

IN SEPTEMBER 1987.

THOUGH THIS WAS AN ACCIDENTAL

RELEASE OF RADIOACTIVE MATERIAL,

IT IS A NOTABLE EXAMPLE

OF THE IMPACT THAT A

RADIOLOGICAL DIS.

PERAL DEVICE COULD HAVE.

IN THIS INCIDENT, PEOPLE SEEKING

SCRAP METAL TO SELL ENTERED

AN ABANDONED CANCER CLINIC

AND REMOVED A DISCARDED

RADIOTHERAPY MACHINE CONTAINING

1375 CURIES OF RADIOACTIVE

CESIUM-137.

THIS IS LESS THAN HALF

OF THE CESIUM-137 FOUND IN ONE

OF THE SEED IRRADIATORS SHOWN

PREVIOUSLY.

JUNKYARD WORKERS OPENED

THE CANISTER AND FOUND A BLUE

POWDER INSIDE, WHICH THEY TOOK

HOME TO THEIR FAMILIES

AND NEIGHBORS.

PEOPLE IN THE COMMUNITY ADMIRED

THIS POWDER BECAUSE THEY FOUND

THAT IT GLOWED WHEN THEY SPREAD

IT ON THEIR SKIN.

AS A RESULT OF THIS ACCIDENTAL

RADIOLOGICAL DISPERSAL EVENT,

249 PEOPLE WERE EXPOSED

TO RADIATION OR CONTAMINATED

WITH CS-137.

54 PEOPLE WERE HOSPITALIZED,

8 WITH RADIATION SICKNESS, 4 OF

WHOM DIED.

HOWEVER, THE IMPORTANT PUBLIC

HEALTH MESSAGE TO REMEMBER

FROM THIS INCIDENT IS THAT,

ALTHOUGH ONLY 249 PEOPLE

IN THE CITY OF GOIANIA WERE

AFFECTED BY THIS INCIDENT,

112,000 PEOPLE DEMANDED TO BE

MONITORED FOR CONTAMINATION

AND SCREENED FOR EXPOSURE.

THAT IS 10% OF THE TOTAL

POPULATION OF GOIANIA.

FURTHERMORE, IT IS INTERESTING

TO NOTE THAT THIS EVENT WAS

FIRST IDENTIFIED APPROXIMATELY

10 DAYS AFTER THE POWDER WAS

FIRST RELEASED FROM THE UNIT.

AND THE PERSON WHO MADE

THE DISCOVERY WAS A PHYSICIAN

WORKING IN A PUBLIC HEALTH

CLINIC WHEN A PATIENT

WITH RADIATION SICKNESS CAME

TO HIM SEEKING TREATMENT.

IF SUCH A RADIOLOGICAL INCIDENT

OCCURS IN THE UNITED STATES, CDC

WILL BE A PART OF THE RESPONSE,

BUT BEFORE WE DISCUSS CDC'S

SPECIFIC ROLES, IT IS IMPORTANT

TO UNDERSTAND HOW CDC FITS

INTO THE GOVERNMENT RESPONSE

STRUCTURE.

FIRST OF ALL, I THINK THAT IT IS

IMPORTANT TO REMIND OURSELVES

THAT ALL EMERGENCIES ARE LOCAL.

IF A TERRORIST ATTACK OCCURS, IT

WILL BE THE RESPONSIBILITY

OF LOCAL PUBLIC HEALTH RESPONSE

ORGANIZATIONS TO DETERMINE

IF THEY NEED THE ASSISTANCE

OF THE STATE PUBLIC HEALTH

ORGANIZATIONS.

IN TURN, IT WILL BE

THE RESPONSIBILITY OF THE STATE

AGENCIES TO DETERMINE

IF THEY NEED THE ASSISTANCE

OF FEDERAL PUBLIC HEALTH

RESPONSE ORGANIZATIONS.

NOW, OBVIOUSLY, MANY AGENCIES,

OTHER THAN PUBLIC HEALTH, WILL

BE INVOLVED, TOO, BUT WE MUST

NEVER FORGET THAT PROTECTING

PEOPLE'S HEALTH IS

THE OVERARCHING GOAL OF ALL

EMERGENCY RESPONSE ACTIVITIES.

WHILE ALL INCIDENTS ARE LOCAL,

IF YOU DEEM THAT YOU NEED

ASSISTANCE, CDC WILL RESPOND.

REMEMBER, YOU ARE NOT ALONE.

NOW, AS YOU ARE UNDOUBTEDLY

AWARE, THE FEDERAL RESPONSE PLAN

IS BEING REPLACED BY THE

NATIONAL RESPONSE PLAN, OR NRP,

WHICH IS CURRENTLY BEING PHASED

IN.

YOU MAY VIEW AND DOWNLOAD

THE NRP FROM THE DEPARTMENT

OF HOMELAND SECURITY WEBSITE

AT WWW.DHS.GOV.

THE NRP INCLUDES THE BASIC PLAN,

PLUS EMERGENCY SUPPORT

FUNCTIONS, SUPPORT AND INCIDENT

ANNEXES, AND APPENDICES.

THE BASIC PLAN PROVIDES

THE STRUCTURE AND PROCESSES

FOR THE NATIONAL INCIDENT

MANAGEMENT APPROACH.

IT INCLUDES THE CONCEPT

OF OPERATIONS, ROLES

AND RESPONSIBILITIES,

IMPLEMENTATION GUIDANCE,

AUTHORITIES,

REFERENCES, AND PREPAREDNESS

AND PLANS MAINTENANCE.

THERE ARE 15 EMERGENCY SUPPORT

FUNCTIONS THAT GROUP

CAPABILITIES AND RESOURCES

INTO FUNCTIONS MOST LIKELY

NEEDED DURING AN INCIDENT.

THESE ESFs DESCRIBE

THE RESPONSIBILITIES OF PRIMARY

SUPPORT AGENCIES THAT ARE

INVOLVED DURING INCIDENTS

OF NATIONAL SIGNIFICANCE.

THE SUPPORT ANNEXES PROVIDE

THE PROCEDURES AND

ADMINISTRATIVE REQUIREMENTS

COMMON TO MOST INCIDENTS.

SUCH THINGS AS PUBLIC AFFAIRS,

FINANCIAL MANAGEMENT, AND WORKER

SAFETY AND HEALTH.

THE INCIDENT ANNEXES DESCRIBE

THE PROCEDURES AND ROLES

AND RESPONSIBILITIES

FOR SPECIFIC CONTINGENCIES SUCH

AS TERRORISM, RADIOLOGICAL

RESPONSE, AND CATASTROPHIC

INCIDENTS.

THESE ANNEXES ARE TYPICALLY

SUPPORTED BY MORE DETAILED

SUPPORTING PLANS.

THE APPENDICES OFFER OTHER

RELEVANT INFORMATION SUCH

AS TERMS AND DEFINITIONS.

THE DEPARTMENT OF HEALTH

AND HUMAN SERVICES, HHS, IS

DESIGNATED AS THE COORDINATING

AGENCY FOR PUBLIC HEALTH

AND MEDICAL SERVICES, WHICH IS

EMERGENCY SUPPORT FUNCTION #8.

IN TURN, HHS HAS TASKED

THE CENTERS FOR DISEASE CONTROL

AND PREVENTION TO COORDINATE

WITH STATE HEALTH AGENCIES

ON ISSUES RELATED TO HEALTH

SURVEILLANCE, WORKER HEALTH

AND SAFETY, PUBLIC HEALTH

INFORMATION, VECTOR CONTROL

AND ALL HAZARD PUBLIC HEALTH

AND MEDICAL CONSULTATION,

TECHNICAL ASSISTANCE

AND SUPPORT.

NOW, AS I MENTIONED PREVIOUSLY,

IN ADDITION TO EMERGENCY SUPPORT

FUNCTIONS, THE NRP INCLUDES

ANNEXES THAT ADDRESS SPECIFIC

EMERGENCIES, ONE OF WHICH IS

THE NUCLEAR/RADIOLOGICAL

INCIDENT ANNEX.

UNDER THIS ANNEX, THE DEPARTMENT

OF HOMELAND SECURITY COORDINATES

THE FEDERAL RESPONSE

TO INCIDENTS OF NATIONAL

SIGNIFICANCE, SUCH AS TERRORIST

INCIDENTS INVOLVING RADIOACTIVE

MATERIALS AND LARGE-SCALE

ACCIDENTS OR INCIDENTS.

THE DEPARTMENT OF JUSTICE IS

THE LEAD AGENCY FOR CRIMINAL

INVESTIGATIONS, BUT

THE COORDINATING AGENCY WILL BE

DETERMINED BY THE TYPE

OF EMERGENCY.

CONSEQUENTLY, THE COORDINATING

AGENCY MAY BE THE NUCLEAR

REGULATORY COMMISSION,

A LICENSED EVENT,

THE DEPARTMENT OF DEFENSE,

THE DEPARTMENT OF ENERGY,

THE NATIONAL AERONAUTICS

AND SPACE ADMINISTRATION,

OR THE ENVIRONMENTAL PROTECTION

AGENCY.

UNDER THIS ANNEX, HHS IS

A COOPERATING AGENCY.

THAT IS, THROUGH OUR

RESPONSIBILITIES AS DEFINED

IN ESF NUMBER 8, HHS WILL

COORDINATE PUBLIC HEALTH ASPECTS

OF THE FEDERAL RESPONSE TO ANY

INCIDENT OF NATIONAL

SIGNIFICANCE INVOLVING NUCLEAR

OR RADIOLOGICAL MATERIAL.

AS PART OF THE

NUCLEAR/RADIOLOGICAL INCIDENT

ANNEX, HHS WILL AID STATE

AND LOCAL PUBLIC HEALTH AGENCIES

IN INSPECTING PRODUCTION,

PROCESSING, STORAGE,

AND DISTRIBUTION FACILITIES

FOR HUMAN FOOD AND ANIMAL FEEDS,

COLLECTING SAMPLES

OF AGRICULTURAL PRODUCTS

TO MONITOR AND ASSESS THE EXTENT

OF CONTAMINATION, PROVIDING

ADVICE ON PROPER MEDICAL

TREATMENT AND PROVIDING ADVICE

AND GUIDANCE IN ASSESSING

THE IMPACT OF THE HEALTH EFFECTS

OF RADIOLOGICAL INCIDENTS.

IN ADDITION, CDC, AS AN AGENT

OF HHS, WILL ASSIST

IN THE MANAGEMENT OF LONG-TERM

PUBLIC MONITORING AND SUPPORT

OF THE AFFECTED POPULATION,

COLLECTING AND PROCESSING BLOOD

SAMPLES, BODILY

FLUIDS/MATTER SAMPLES

AND ADVISING ON MEDICAL

ASSESSMENT AND TRIAGE

OF VICTIMS.

CDC AND HHS WILL ALSO ASSIST

STATES IN TRACKING VICTIMS'

TREATMENTS AND LONG-TERM HEALTH

EFFECTS ANDPROVIDE ASSESSMENT

AND TREATMENT TEAMS FOR THOSE

EXPOSED TO RADIATION,

OR CONTAMINATED WITH RADIOACTIVE

MATERIALS.

CDC WILL RESPOND IF AND WHEN

YOU DETERMINE THAT WE ARE

NEEDED.

CDC WILL NOT COME TO YOUR CITY

OR COUNTY AND TAKE

OVER FROM THE PEOPLE WHO KNOW

THE AREA AND THE RESIDENTS BEST.

THAT IS WHY IT IS ESPECIALLY

IMPORTANT FOR STATE AND LOCAL

PUBLIC HEALTH PROFESSIONALS

TO UNDERSTANDTHEIR ROLES

IN RESPONSE TO A NUCLEAR

OR RADIOLOGICAL INCIDENT.

I'M GOING TO LET

MS. DEBRA McBAUGH COVER

THE LOCAL RESPONSE ROLES

IN THE NEXT SECTION OF THIS

PRESENTATION.

>> THANK YOU, DR. MILLER.

>>> WE HAVE HEARD PUBLIC HEALTH

PROFESSIONALS EXPRESS A LOT

OF CONFUSION REGARDING

THEIR PARTICULAR ROLES

DURING A NUCLEAR OR RADIOLOGICAL

INCIDENT.

DURING 2003 AND 2004,

THE ASSOCIATION OF SCHOOLS

OF PUBLIC HEALTH CONDUCTED FOCUS

GROUPS WITH A VARIETY OF PEOPLE

FROM AROUND THE UNITED STATES.

AS PART OF THIS WORK, 13 FOCUS

GROUPS WERE CONDUCTED

WITH MEMBERS OF STATE AND LOCAL

PUBLIC HEALTH AGENCIES.

DURING THESE FOCUS GROUPS,

PUBLIC HEALTH WORKERS EXPRESSED

CONCERN WITH THEIR ROLES

IN RESPONSE TO A NUCLEAR

OR RADIOLOGICAL INCIDENT.

ONE PARTICIPANT STATED, "I

HAVEN'T HEARD THAT I AM INVOLVED

AND I DON'T WANT TO

BE INVOLVED."

AND ANOTHER PARTICIPANT ADDED,

"RIGHT NOW, THE LAB HAS

NO PLANS, AND IS NOT DIRECTLY

INVOLVED.

WE ARE MORE INVOLVED IF THERE IS

A BIOLOGICAL ATTACK."

BUT THE TRUTH IS THAT SHOULD A

NUCLEAR OR RADIOLOGICAL

INCIDENT OCCUR, EVERYONE

IN THE PUBLIC HEALTH SYSTEM WILL

VA ROLE, BUT ARE WE READY TO

RESPOND?

DESPITE THE INCREASE IN FEDERAL

AID TO PREPARE THE PUBLIC HEALTH

WORKFORCE, WE STILL HAVE MUCH

TO DO TO BE READY TO RESPOND TO

AN INCIDENT.

SOME THINGS THAT PUBLIC HEALTH

PROFESSIONALS SHOULD DO

IN PREPARATION INCLUDE

DEVELOPING PARTNERSHIPS

WITH OTHER STATE AND LOCAL

AGENCIES, COMMUNICATE

WITH AGENCIES AND STAKEHOLDERS

FROM INSIDE AND OUTSIDE

THE PUBLIC HEALTH COMMUNITY,

AND MAKE PLANS AND CONDUCT

DRILLS WITH THESE STAKEHOLDERS.

THE MORE PREPARED WE ARE TO

WORK TOGETHER, THE SMOOTHER

OPERATIONS WILL RUN

DURING AN ACTUAL EVENT.

IDENTIFY TEAM ROLES AND PEOPLE

WITHIN THE COMMUNITY WHO CAN

FILL THESE ROLES.

DETERMINE PUBLIC HEALTH ROLES

WITHIN THE INCIDENT COMMAND

STRUCTURE AND IDENTIFY WHO WILL

FILL THOSE ROLES.

DEVELOP COMMUNICATIONS MESSAGES

FOR A VARIETY OF SCENARIOS

AND KEEP THEM ON HAND

FOR TAILORING POST-EVENT.

IT IS MUCH EASIER TO DEVELOP

MESSAGES IN ADVANCE THAN

DURING THE CONFUSION THAT

FOLLOWS A MAJOR INCIDENT.

FIND OUT WHO IS RESPONSIBLE

FOR WHAT ACTIONS IN YOUR STATE

AND HOW TO CONTACT THESE PEOPLE.

AND DEVELOP A LIST OF RESOURCES

AVAILABLE WITHIN YOUR STATE

AND COMMUNITY.

INCLUDE WEBSITES, SUCH AS THE

CDC RADIATION EMERGENCIES

WEBSITE, AND CONTACT INFORMATION

FOR SEVERAL GROUPS, INCLUDING

LOCAL FIRE DEPARTMENTS,

EPA REGIONAL OFFICE, HAZMAT

TEAMS, LOCAL NUCLEAR MEDICINE

STAFF AND RADIOACTIVE MATERIAL

LICENSES, BOTH OF WHICH HAVE

RADIATION DETECTORS, AND PEOPLE

FAMILIAR WITH RADIATION AN HOW

TO HANDLE RADIOACTIVE MATERIALS.

MOST IMPORTANTLY, I ENCOURAGE

YOU TO HAVE THE NAME AND CONTACT

INFORMATION FOR YOUR STATE

RADIATION CONTROL PROGRAM

DIRECTOR.

THIS PERSON IS VITAL IN BOTH

PLANNING FOR AND RESPONDING

TO A NUCLEAR OR RADIOLOGICAL

INCIDENT.

IN PLANNING, REMEMBER ASSISTANCE

IS ALSO AVAILABLE FROM FEDERAL

AGENCIES.

THE CDC WILL ASSIST

YOU IN RESPONDING.

AND RESOURCES, SUCH

AS THE FEDERAL RADIOLOGICAL

MONITORING AND ASSESSMENT

CENTER, KNOWN AS FRMAC, ARE

AVAILABLE THROUGH THE DEPARTMENT

OF HOMELAND SECURITY

FOR SURVEYING THE SCENE

AND DETERMINING RADIATION

LEVELS.

THIS ASSISTANCE MUST BE

REQUESTED BY THE GOVERNOR

OR TRIBAL LEADER.

UNTIL THIS REQUEST IS MADE,

COMMUNITY LEADERS ARE

RESPONSIBLE FOR COORDINATING

THE RESPONSE.

REMEMBER, EVEN WHEN CDC

AND OTHER FEDERAL AGENCIES'

ARRIVE, THEY WILL PROVIDE

ASSISTANCE AND RECOMMENDATIONS

ONLY.

MOST OF THE MAJOR RESPONSE ROLES

AND CERTAINLY THE RESPONSIBILITY

FOR THEM, WILL STILL FALL TO THE

LOCAL PUBLIC HEALTH

PROFESSIONALS.

WITHIN THE LOCAL GOVERNMENT,

THE CHIEF EXECUTIVE OFFICER,

THAT IS THE MAYOR OR CITY

OR COUNTY MANAGER, IS

RESPONSIBLE FOR COORDINATING

THE LOCAL RESPONSE

AND RESOURCES.

IF NECESSARY, HE OR SHE MAY

SUSPEND LOCAL LAWS

AND, FOR EXAMPLE,

ESTABLISHING A CURFEW

OR DIRECTING THAT AN AREA BE

EVACUATED.

THEY ARE ALSO RESPONSIBLE

FOR COMMUNICATING

WITH THE PUBLIC.

THE TRIBAL CHIEF EXECUTIVE

OFFICER HAS ALL OF THE SAME

RESPONSIBILITIES AS THE LOCAL,

AND IN ADDITION, MAY COMMUNICATE

DIRECTLY WITH FEDERAL OFFICIALS

TO REQUEST ASSISTANCE,

WITHOUT GOING THROUGH

THE STATE GOVERNOR.

SHOULD A NUCLEAR OR RADIOLOGICAL

INCIDENT OCCUR, STATE AND LOCAL

PUBLIC HEALTH NEED TO BE

PREPARED TO DO MANY THINGS.

SOME THINGS TO KEEP IN MIND

AS YOU PREPARE ARE THAT

THE WORKFORCE WILL BE

RESPONSIBLE FOR

MONITORING WORKERS' HEALTH AND

SAFETY.

ASSURING THERE ARE

PLENTY OF SAFE SHELTERS

AND HEALTHY FOOD AND WATER

SUPPLIES.

COORDINATING SAMPLING

AND LABORATORY ANALYSIS

OF BIOLOGICAL AND ENVIRONMENTAL

SAMPLES.

CONDUCTING FIELD

INVESTIGATIONS AND MONITORING

PEOPLE WHO WERE POSSIBLY

CONTAMINATED WITH RADIOACTIVE

MATERIALS OR EXPOSED

TO RADIATION.

DEVELOPING CRITERIA FOR ENTRY

AND OPERATIONS WITHIN THE

INCIDENT SITE.

AND RECOMMENDING DISEASE CONTROL

AND PREVENTION MEASURES.

IF REQUESTED, CDC WILL ASSIST

IN THESE TASKS.

THERE IS ALSO FEDERAL GUIDANCE

AVAILABLE FROM EPA AND DHS.

MEDICAL SUPPORT WILL BOTH BE

NEEDED IN THE SHORT AND LONG

TERM.

THE STATE AND LOCAL PUBLIC

HEALTH AGENCIES, WITH ASSISTANCE

FROM FEDERAL PARTNERS, WILL

EVALUATE THE HEALTH AND MEDICAL

IMPACT ON THE PUBLIC AND

EMERGENCY PERSONNEL.

THEY WILL DEVELOP

MEDICAL INTERVENTION

RECOMMENDATIONS, TREAT IMPACTED

CITIZENS AND, IF NECESSARY,

REQUEST THAT CDC DEPLOY

THE STRATEGIC NATIONAL

STOCKPILE, FORMERLY KNOWN

AS THE NATIONAL PHARMACEUTICAL

STOCKPILE.

STATE AND LOCAL PUBLIC HEALTH

PROFESSIONALS ALSO WILL BE

RESPONSIBLE FOR IMPLEMENTING

PROTECTIVE ACTION GUIDES,

INCLUDING RECOMMENDATIONS

FOR SHELTERING, EVACUATION,

RELOCATION, WHICH IS PERMANENT

EVACUATION, DECONTAMINATION

AND WORKER PERSONAL PROTECTIVE

EQUIPMENT.

THESE ARE OUTLINED IN FEDERAL

GUIDANCE SUCH AS EPA'S MANUAL

OF PROTECTIVE ACTION GUIDES

AND PROTECTIVE ACTIONS

FOR NUCLEAR INCIDENTS, WHICH IS

EPA DOCUMENT NUMBER 400.

CDC WILL ALSO OFFER ADVICE

AND ASSIST IN DEVELOPING THESE

RECOMMENDATIONS IF REQUESTED

TO DO SO BY STATE AND LOCAL

GOVERNMENTS.

NONETHELESS, WE SHOULD BE

PREPARED WITHIN OUR COMMUNITIES

TO GIVE IMMEDIATE PROTECTIVE

ACTION RECOMMENDATIONS

IN THE EVENT OF A NUCLEAR

OR RADIOLOGICAL TERRORIST

ATTACK.

AS AN EXAMPLE, IF WE CONSIDER

THE MOST LIKELY RADIOLOGICAL

TERRORIST INCIDENT,

A DIRTY BOMB, THE PRESENCE

OF RADIATION MAY NOT BE

IMMEDIATELY APPARENT.

HOWEVER, IF AN EXPLOSION OCCURS

IN THE COMMUNITY, THERE ARE SOME

SIMPLE PROTECTIVE ACTIONS THAT

THE LOCAL CHIEF EXECUTIVE

OFFICER OR PUBLIC HEALTH

OFFICIAL CAN GIVE TO PEOPLE

IN THE EFFECTED AREA.

EVEN BEFORE PEOPLE KNOW WHETHER

OR NOT RADIOACTIVE MATERIALS

WERE PRESENT, FOLLOWING THESE

SIMPLE STEPS CAN HELP REDUCE

THEIR INJURY FROM RADIATION

OR CHEMICALS THAT MIGHT HAVE

BEEN PRESENT IN THE BLAST.

IF YOU ARE INSIDE, YOU SHOULD

SHELTER IN PLACE.

THIS MEANS STAY INSIDE, TURN OFF

VENTILATION SYSTEMS THAT BRING

IN AIR FROM THE OUTSIDE, AND USE

RECIRCULATED AIR.

CLOSE ALL WINDOWS, DOORS AND

FIREPLACE DAMPERS.

SHELTERING WILL GENERALLY BE

IN EFFECT FOR LESS THAN

24 HOURS, AT WHICH POINT SAFE

PATHS OF EGRESS WILL BE

DETERMINED BY PUBLIC HEALTH

AGENCIES.

FOR AN RDD, EVACUATION MAY NEVER

BE NECESSARY.

IF YOU ARE OUTSIDE, COVER

YOUR NOSE AND MOUTH

WITH A CLOTH.

THIS WILL REDUCE THE CHANCES

OF INHALING OR INGESTING

RADIOACTIVE MATERIALS.

LEAVE THE IMMEDIATE AREA AND GO

INSIDE THE NEAREST BUILDING.

STAY INSIDE, AND FOLLOW

THE STEPS RECOMMENDED

FOR SHELTERING.

STAYING INSIDE WILL REDUCE

PEOPLE'S EXPOSURE TO ANY

RADIOACTIVE MATERIAL THAT MAY BE

ON DUST AT THE SCENE.

IF YOU THINK YOU MAY BE

CONTAMINATED, REMOVE THE OUTER

LAYER OF CLOTHES AS SOON

AS POSSIBLE, PLACE THEM

IN A PLASTIC BAG, AND SEAL IT.

AS DR. SMITH TOLD US EARLIER,

REMOVING CLOTHING CAN REMOVE

A SIGNIFICANT PORTION

OF EXTERNAL CONTAMINATION.

SAVING THE CLOTHING IN A PLASTIC

BAG WOULD ALLOW FOR TESTING

FOR RADIOACTIVE CONTAMINATION

LATER.

TAKE A SHOWER OR WASH AS SOON

AS POSSIBLE.

WASHING WILL REDUCE THE AMOUNT

OF RADIOACTIVE CONTAMINATION

ON THE BODY AND EFFECTIVELY

REDUCE TOTAL EXPOSURE.

TUNE IN TO YOUR LOCAL EMERGENCY

BROADCAST SYSTEM, IF POSSIBLE.

BE ON THE LOOKOUT

FOR INFORMATION.

ONCE EMERGENCY PERSONNEL CAN

ASSESS THE SCENE AND THE DAMAGE,

THEY WILL BE ABLE TO TELL PEOPLE

WHETHER RADIATION WAS INVOLVED.

AND MOST IMPORTANTLY, ENCOURAGE

PEOPLE TO SEEK MEDICAL ATTENTION

ONLY FOR SEVERE INJURIES, NOT

FOR CONTAMINATION.

IN THE EVENT OF AN EMERGENCY,

MEDICAL SYSTEMS COULD QUICKLY

BECOME OVERWHELMED WITH PATIENTS

AND WE WANT TO BE SURE THAT

THE SEVERELY INJURED GET

TREATED FIRST.

ASSURE PEOPLE THAT MONITORING

STATIONS WILL BE SET UP AS SOON

AS POSSIBLE TO DEAL

WITH POSSIBLE EXPOSURE

AND CONTAMINATION.

OVER THE COURSE OF THE CLEAN-UP

AND RECOVERY, STATE AND LOCAL

PUBLIC HEALTH AGENCIES WILL

COLLABORATE WITH FEDERAL

AGENCIES, SUCH AS DHS, EPA,

AND THE FOOD AND DRUG

ADMINISTRATION TO APPLY

PROTECTIVE ACTION GUIDES FOR

FOOD AND WATER.

FOR NON-FOOD USE OF AGRICULTURE

PRODUCTS AND RECOVERY

OPERATIONS.

AS PART OF THIS, THEY WILL

DEVELOP LONG-TERM PLANS

FOR DECONTAMINATION, RE-ENTRY

INTO CONTAMINATED AREAS,

AND FOR FINAL RECOVERY OF THE

INCIDENT SITE AND THE

SURROUNDING AREAS.

THEY WILL ALSO CONDUCT LONG-TERM

SURVEILLANCE AND EPIDEMIOLOGICAL

STUDIES.

ASSIST IN THE ESTABLISHMENT

OF AN EXPOSURE REGISTRY

TO MONITOR LONG-TERM HEALTH

IMPACTS FROM THE INCIDENT.

AND PROVIDE INFORMATION

TO THE PUBLIC AND RESPONDERS

ON LONG-TERM HEALTH EFFECTS

ASSOCIATED WITH EXPOSURE

TO RADIATION.

FOR MORE

INFORMATION ON RADIATION

PROTECTION, YOU CAN VISIT

THE CDC RADIATION EMERGENCIES

WEBSITE WHERE YOU CAN FIND FACT

SHEETS ON RADIATION, MEDICATIONS

TO TREAT INTERNAL CONTAMINATION,

VARIOUS RADIOISOTOPES,

AND EVACUATION AND SHELTERING.

YOU CAN VIEW AND DOWNLOAD

THE NATIONAL RESPONSE PLAN

FROM THE DEPARTMENT OF HOMELAND

SECURITY WEBSITE.

OTHER GUIDANCE ON RESPONSE

AND RECOVERY WILL SOON BE

AVAILABLE ALSO.

THE ENVIRONMENTAL PROTECTION

AGENCY'S RADIATION PROTECTION

PAGE OFFERS RECOMMENDATIONS

FOR PROTECTING PEOPLE

AND THE ENVIRONMENT

AND THE NUCLEAR REGULATORY

COMMISSION OFFERS RADIATION

PROTECTION AND REGULATORY

GUIDELINES AT ITS WEBSITE.

WHILE IT MAY SEEM THAT AS STATE

AND LOCAL PUBLIC HEALTH

PROFESSIONALS WE ARE TASKED

WITH ENORMOUS RESPONSIBILITIES

IN RESPONSE TO A NUCLEAR

OR RADIOLOGICAL EVENT, IT IS

IMPORTANT TO RE-EMPHASIZE

SOMETHING THAT DR. MILLER SAID

EARLY, AND THAT IS --

YOU ARE NOT ALONE.

IF SUCH AN EVENT OCCURS, CDC,

HHS, DHS, AND OTHER FEDERAL

AGENCIES ARE READY TO RESPOND

AND ASSIST YOUR COMMUNITY

IN DEALING WITH AND RECOVERING

FROM A NUCLEAR OR RADIOLOGICAL

TERRORIST ATTACK.

AND WE ARE GOING TO WANT

THAT ASSISTANCE.

>> THANK YOU SO MUCH.

YOUR INFORMATION AND, OF COURSE,

ALL OF THE INFORMATION PROVIDED

TODAY WILL CERTAINLY GO A LONG

WAY IN HELPING HEALTH CHAIR

WORKERS AND FOUNDATIONS FOR

PREPARING AND RESPONDING TO ANY

SUCH RADIOLOGICAL OR NUCLEAR

INCIDENT.

NOW, FOR THE REST OF

THE BROADCAST, WE'D LIKE

TO ADDRESS SOME OF THE QUESTIONS

THAT YOU HAVE SUBMITTED.

IF YOU DO NOT HAVE YOUR QUESTION

ANSWERED DURING TODAY'S

BROADCAST, WE'LL CONTACT

YOU LATER WITH APERSONAL

FOLLOW-UP.

LET'S GET STARTED.

OUR FIRST QUESTION IS FOR YOU,

DR. MILLER FROM PAUL IN IDAHO.

HE ASKS --

CAN SPAWNS FROM THE CDC

COOPERATIVE AGREEMENT ON PUBLIC

PREPAREDNESS AND BIOTERRORISM

WILL USED FOR NUK

CHREER/RADIOLOGICAL

PREPAREDNESS?

>> PAUL, A VERY INTERESTING

QUESTION.

IN FACT, PROBABLY ONE I RECEIVE

MORE OFTEN THAN ANY OTHER WHEN

I'M OUT TALKING WITH STATE AND

LOCAL PUBLIC HEALTH OFFICIALS.

NOW, I'M NOT AN ACTIVE

PARTICIPANT IN ADMINISTERING THE

COOPERATIVE AGREEMENT AND I DO

KNOW THERE'S NOWHERE IN THE

GUIDE ANSWER THAT I'VE BEEN ABLE

TO FIND, IN OTHER WORDS, NUCLEAR

OR RADIOLOGICAL, WHERE IT'S

MENTIONED.

HOWEVER, THERE IS A STATEMENT IN

THERE THAT'S A GRANT, AN

AGREEMENT CAN BE USED FOR OTHER

POTENTIAL PUBLIC HEALTH

EMERGENCIES.

LIKE THOSE THAT ARE LISTED

SPECIFICALLY.

AND I DO KNOW OF AT LEAST ONE OR

TWO OTHER STATES WHO HAVE USED

THE COOPERATIVE AGREEMENT

FUNDING TO SUPPORT RADIATION

PREPARATION EFFORTS.

IN ASKING US TO CHANGE HEAR AT

CDC IT IS MY UNDERSTANDING THAT,

IN FACT THAT IS PERFECTLY

ACCEPTABLE.

IT IS UP TO THE STATES TO DECIDE

HOW THOSE FUNDS ARE DISPERSED

AND NUCLEAR AND RADIOLOGICAL

EXPENSES CAN BE INCLUDED.

>> FROM OHIO, TWO-PART QUESTION.

THE FDA RECENTLY APPROVED DTPA

FOR TREATING INTERNAL

MEDICATION.

THAT'S THE WHOLE ROLE OF THIS

MEADATION AND SHOULD CITIES AND

STATES STOCKPILE THIS

MEDICATION?

>> THAT'S A RELEVANT AND TIMELY

QUESTION.

THANK YOU FOR THAT.

YES, DTPA HAS BEEN APPROVE

RECENTLY FOR USE FOR PEOPLE WHO

HAVE BEEN VERY HEAVILY

CONTAMINATED WITH A CERTAIN

CLASS OF RADIOACTIVE SUBSTANCES.

THE CALCIUM AND ZINC SALTS OF

DTPA BIND WITHIN THE BODY TO THE

SUBSTANCES AND ACCELERATE THE

EXCRETION OF THE SUBSTANCES FROM

THE BODY THROUGH THE URINE.

NOW, OF COURSE, ADMINISTRATION

OF SUCH DRUGS SHOULD ONLY BE

DONE UNDER THE SUPERVISION OF A

PHYSICIAN.

AND THE DRUG IS ONLY -- WE HAVE

MORE GENERAL INFORMATION ABOUT

THAT ON OUR CDC WEBSITE, AND WE

ALSO HAVE LINKS THERE TO THE FDA

WEBSITE AND OTHER RELEVANT

WEBSITES, WHICH HAVE A LOT MORE

SPECIFIC INFORMATION ABOUT DTPA

AND THOSE OTHER TYPES OF DRUGS

LIKE THAT'S NOW, WITH REGARD TO

THE QUESTION OF STATE AND LOCAL

GOVERNMENT STOCKPILING DTPA OR

ANY OTHER TYPE OF MEDICATION,

THAT'S REALLY A LOCAL DECISION.

HOWEVER, I WOULD POINT OUT, KYSA

THAT OUR STRATEGIC NATIONAL

STOCKPILE IS CURRENTLY WORKING

WITH FDA TO ACQUIRE AND

STOCKPILE THIS RECENTLY APPROVED

DTPA.

>> OKAY.

GOOD DEAL.

DAVID OF CALIFORNIA HAS A

QUESTION HE WANTS TO KNOW.

HE SAYS, I'M LOCATED IN A SMALL

COMMUNITY ONE HOUR FROM A MAJOR

METROPOLITAN AREA.

HOW WILL I BE AFFECTED BY A

TERRORIST ATTACK IN THAT CITY,

AND MS. McBAUGH, CAN YOU ANSWER

THAT?

>> YEAH.

IT'S VERY LIKE TLA MANY PEOPLE

WILL SELF-EVACUATE FROM THAT

LARGE CITY.

AND MANY OF THEM COULD

POTENTIALLY BE CONTAMINATED.

SO IT WOULD BE VERY GOOD AS A

SMALL COMMUNITY TO TALK WITH ALL

THOSE PEOPLE WHO COULD

POTENTIALLY HELP.

TALK TO YOUR HOSPITALS, YOUR

NUCLEAR MEDICINE CLINIC, AND TO

FIRE DEPARTMENTS.

ANYONE THAT CAN HELP YOU IN THIS

AREA AND BUILD RELATIONSHIPS

WITH THEM SO THAT YOU CAN

INTERACT TOGETHER.

IT'S VERY POSSIBLE THAT MANY OF

YOUR PROCEDURES THAT YOU

NORMALLY DEAL, WHEN DEALING WITH

PEOPLE THAT NEED SHELTERS OR

MEDICAL CARE, THOSE PROCEDURES

WILL BE THE SAME WITH THE ADDED

ASPECT OF HAVING POTENTIAL RADIO

ACTIVITY INVOLVED.

JOIN SOME SIMPLE TABLETOP

EXERCISES WITH ALL OF THOSE

PEOPLE THAT CAN HELP YOU AHEAD

OF TIME WOULD BE VERY HELPFUL TO

ADD THAT ASPECT TO YOUR PLAN.

>> OKAY.

DR. MILLER, WE HAVE ABOUT A

MINUTE LEFT, BUT GLEN OF

MARYLAND WANTS TO KNOW WHAT

GUIDELINES WOULD YOU RECOMMEND

FOR FIRST RESPONDERS TO AN

EXPLOSION WITH RADIATION LEVELS

SIGNIFICANTLY ABOVE THAT GROUND?

>> GOOD QUESTION.

THE FEDERAL GOVERNMENT HAS PUT

OUT SOME GUIDANCE IN THAT ISSUE.

SUCH AS EPA DOCUMENT NUMBER 400,

THAT MS. McBAUGH REFERRED TO A

MINUTE AGO, AND THERE ARE OTHER

PLACES YOU CAN GO.

ULTIMATELY, THE LIMIT TO

RESPONDERS TO ANY KIND OF EVENT

LIKE THIS IS UP TO THE STATE AND

LOCAL RESPONDING ORGANIZATION.

SO I WOULD ENCOURAGE STATE AND

LOCAL RESPONDERS TO GO LOOK AT

THE GUIDANCE, AND THEN WORK

TOGETHER TO DETERMINE WHAT

THOUGH LIMITS MIGHT BE.

>> ALL RIGHT.

YOU DID THAT VERY QUICKLY.

SO QUICKLY WE HAVE TIME FOR ONE