The Role of Public
Health in a
Nuclear or Radiological Terrorist Incident
Script
CDC0203.05
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2005.
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\M\M
>>> 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
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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THE UNITED STATES, THE NUMBER TO
DIAL IS --
800-793-8598.
IF YOU ARE AN INTERNATIONAL
VIEWER, YOU CAN CALL --
404-639-0180.
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OR COMMENTS TO US AT --
800-553-6323.
FOR THOSE OF YOU OUTSIDE
THE UNITED STATES,
THE FAX NUMBER IS --
404-639-0181.
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THE INTERNATIONAL TTY NUMBER IS
404-639-0182.
TECHNICAL ASSISTANCE FOR THIS
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?
\B
>> 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,
ENVIRONMENTAL HEALTH, CENTERS
FOR DISEASE CONTROL
AND PREVENTION.
AND DEBRA McBAUGH, CHP,
FROM THE
DEPARTMENT OF HEALTH.
A HEALTH PHYSICIST AND HEAD
OF THE ENVIRONMENTAL RADIATION
SECTION, DEPARTMENT OF HEALTH,
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
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
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
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
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
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
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
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
OR
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
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
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
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
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
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
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
MORE QUESTION, DR. SMITH.
FROM
CHILDREN ARE MORE SENSITIVE TO
RADIATION THAN ADULTS.
HOW MUCH MORE SENSITIVE THAN
ADULTS?
>> A GOOD QUESTION.
WE GET THAT TYPE OF QUESTION
OFTEN.
WELL, JUST A BRIEF ANSWER TO
THAT.
LET'S TAKE, FOR EXAMPLE, A
5-YEAR-OLD CHILD AND A
35-YEAR-OLD ADULT, AND LET'S SAY
THEY GET THE SAME SIGNIFICANT
LEVEL OF A WHOLE BODY ACUTE
RADIATION DOSE.
WE WOULD EXPECT THE 5-YEAR-OLD
CHILD TO HAVE ABOUT DOUBLE THE
RISK OF EVENTUALLY GETTING A
RADIATION-INDUCED CANCER THAN
WOULD THE ADULT.
>> WOW.
ALL RIGHTY.
UNFORTUNATELY, WE ARE OUT OF
TIME.
I'M ANSWERING YOUR QUESTIONS
DURING THIS BROADCAST.
IF YOU SUBMITTED A QUESTION, WE
WILL CONTACT YOU, AGAIN,
PERSONALLY WITH AN ANSWER.
THE E-MAIL IS RSD@CDC.GOV.
YOU MAY USE THIS ADDRESS TO
E-MAIL
QUESTIONS, COMMENTS OR
REQUESTS FOR FURTHER
INFORMATION.
FINALLY, AN ARCHIVE OF THIS
PROGRAM WILL BE AVAILABLE FOR
VIEWING AT THIS WEBSITE --
WWW.PHPPO.CDC.GOV/PHTN/DEFAULT.A
THAT'S ASP.
ALSO, CE CREDITS FOR
THE ARCHIVED WEBCAST WILL EXPIRE
ON
IN ADDITION, VIDEOTAPES
AND CD-ROMS OF THIS PROGRAM WILL
SOON BE AVAILABLE AT NO COST
AT RSB@CDC.GOV.
IF YOU WISH TO RECEIVE
CONTINUING EDUCATION CREDIT
FOR TODAY'S PROGRAM, YOU MUST
REGISTER AND COMPLETE
AN EVALUATION.
CME, CNE, CEU AND CECH
FOR HEALTH EDUCATORS ARE
AVAILABLE FOR THIS PROGRAM
THROUGH THE CDC ATSDR CONTINUING
EDUCATION AND TRAINING ONLINE
SYSTEM.
WE WANT EVERYONE TO REGISTER
AND COMPLETE THE COURSE
EVALUATION, EVEN IF YOU ARE NOT
TAKING THE PROGRAM
FOR CONTINUING EDUCATION CREDIT.
FOR THOSE OF YOU WHO DO NOT WISH
TO RECEIVE CE CREDIT OR
CERTIFICATE OF ATTENDANCE, WILL
BE AWARDED TO PARTICIPANTS WHO
REGISTER AND COMPLETE THE COURSE
EVALUATION.
YOU MAY RECEIVE ONE HOUR
OF CONTINUING EDUCATION CREDIT
OF AT NO CHARGE BY VISITING
WWW.PHPPO.CDC.GOV/PTHNONLINE.
BE CERTAIN TO JOT DOWN
THE VERIFICATION CODE YOU WILL
SEE IN JUST A MOMENT, SINCE YOU
WILL NEED THIS TO GAIN ACCESS TO
THE CE CREDIT.
AND TO RECEIVE CONTINUING
EDUCATION FOR THIS PROGRAM YOU
NEED TO KNOW TWO IMPORTANT
PIECES OF INFORMATION --
THE FIRST IS THE COURSE NUMBER.
THE COURSE NUMBER FOR THIS
SATELLITE BROADCAST IS SB 0168.
THE COURSE NUMBER FOR THIS
WEBCAST IS WC 0068 AND
THE COURSE NUMBER
FOR WEB ON DEMAND IS WD0062.
YOU WILL NEED ONE OF THESE
COURSE NUMBERS TO IDENTIFY
THE CORRECT EVALUATION
IN THE CDC ATSDR ONLINE SYSTEM.
SO, PLEASE, JOT IT DOWN RIGHT
NOW.
THE SECOND CRITICAL ITEM IS
THE COURSE VERIFICATION CODE.
EVERYONE MUST HAVE THIS
VERIFICATION CODE.
AND IT IS RADTERRORISM.
RADTERRORISM.
THE CODE MUST BE ENTERED
IN UPPER CASE, AND BE CAREFUL,
BECAUSE IT IS CASE SENSITIVE.
SO, PLEASE, WRITE IT DOWN
AND ENTER IT IN UPPER CASE
LETTERS WHEN PROMPTED.
THE EVALUATION FOR THIS PROGRAM
WILL BE ACTIVE ON THE ONLINE
SYSTEM FOR 30 DAYS AFTER
THE LIVE BROADCAST.
REGISTRATION AND EVALUATION MUST
BE COMPLETED NO LATER THAN
CE CREDIT.
MANY OF YOU ARE ALREADY FAMILIAR
WITH USING THE CDC ATSDR ONLINE
REGISTRATION AND EVALUATION
SYSTEM.
IF YOU HAVE NOT USED IT BEFORE,
YOU CAN RECEIVE INSTRUCTIONS
THROUGH OUR FAX BACK SYSTEM.
CALL OUR TOLL FREE NUMBER USING
A TOUCH-TONE TELEPHONE.
THE NUMBER TO DIAL IS --
888-CDC-FAXX.
WHEN PROMPTED FOR A DOCUMENT
NUMBER, REQUEST DOCUMENT
NUMBER 130026, THEN ENTER
YOUR FAX NUMBER.
THE DOCUMENT WILL BE FAXED
TO YOU IN ONLY A FEW MINUTES
AFTER YOU DO THAT.
HERE IS THE ADDRESS
FOR THE CDC ATSDR TRAINING
AND CONTINUING EDUCATION ONLINE
SYSTEM --
WWW.PHPPO.CDC.GOV/PHTNONLINE.
WHEN YOU GET TO THE WEBSITE, AN
EXTENSIVE HELP FUNCTION CAN ALSO
ASSIST YOU IN THE REGISTRATION
PROCESS.
RATHER THAN GO THROUGH ALL
THE DETAILS OF USING THE ONLINE
SYSTEM, YOU SHOULD USE
THE INSTRUCTIONS ON THE WEBSITE,
OR ORDER THE INSTRUCTIONS
FROM OUR FAX BACK SYSTEM.
IN ADDITION TO THE ONLINE HELP
FUNCTION, YOU CAN RECEIVE
ASSISTANCE, THE OLD-FASHIONED
WAY, BY TELEPHONE.
IF YOU HAVE ANY PROBLEMS
WITH THE ONLINE SYSTEM, YOU CAN
CALL US TOLL FREE
AT 800-41-TRAIN.
T-R-A-I-N.
YOU CAN ALSO CALL US
AT 404-639-1292.
CE UNIT PERSONNEL ARE AVAILABLE
MONDAY THROUGH FRIDAY
FROM
AND THAT IS EASTERN TIME.
YOU CAN ALSO RECEIVE ASSISTANCE
BY E-MAIL.
OUR ADDRESS IS CE" CDC.GOV.
THE CONTINUING EDUCATION STAFF
WILL BE HAPPY TO ASSIST
YOU WITH THE LOGIN
AND REGISTRATION PROCESS.
FINALLY, I'D LIKE TO THANK
OUR GUESTS, JAMES SMITH,
MS. McBAUGH AND CHARLES MILLER.
WE APPRECIATE ALL THE
INFORMATION YOU GAVE IT WILL GO
A LONG WAY IN HELPS
PREPARED.
AND I'D ALSO LIKE TO THANK OUR
VIEWERS FOR SUBMITTING THE
QUESTIONS FOR GUESTS DURING
TODAY'S PROGRAM.
MANY THANKS TO YOU.
>>> THAT BRINGS US TO THE CLOSE
OF THE ROLE OF PUBLIC HEALTH IN
THE A NUCLEAR OR RADIOLOGICAL
TERRORIST INCIDENT.
I'M KYSA DANIELS, AND IT
CERTAINLY HAS BEEN MY PLEASURE
TO BE YOUR MODERATOR TODAY.
GOOD-BYE.
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