An Update on Population Monitoring Activities at CDC Charles W. Miller, PhD Armin Ansari, PhD, CHP Radiation Studies Branch Division of Environmental Hazards

An Update on PopulationMonitoring Activities at CDC

An Update on PopulationMonitoring Activities at CDC

Charles W. Miller, PhDArmin Ansari, PhD, CHP

Radiation Studies BranchDivision of Environmental Hazards & Health Effects

National Center for Environmental Health Centers for Disease Control & Prevention

Atlanta, Georgia

Charles W. Miller, PhDArmin Ansari, PhD, CHP

Radiation Studies BranchDivision of Environmental Hazards & Health Effects

National Center for Environmental Health Centers for Disease Control & Prevention

Atlanta, Georgia

OverviewOverview

• What is “Population monitoring”?

• Who is responsible for it?

• Federal agency support, roles, responsibilities

• CDC’s efforts in the area of population monitoring

• What next?

• What is “Population monitoring”?

• Who is responsible for it?

• Federal agency support, roles, responsibilities

• CDC’s efforts in the area of population monitoring

• What next?

Potential Nuclear/Radiological Incidents

Potential Nuclear/Radiological Incidents

• Transportation• Power Plant• Weapons• Laboratory• Industrial• Medical• Space• Terrorism

• Transportation• Power Plant• Weapons• Laboratory• Industrial• Medical• Space• Terrorism

http://www.llnl.gov/str/Sween.html

Terrorism ScenariosTerrorism Scenarios

• IND – Improvised Nuclear Device

• RDD – Radiological Dispersal Device– may or may NOT involve explosion

• RED – Radiological Exposure Device A device whose purpose is to expose

people to radiation, rather than to disperse radioactive material. “silent source”

• IND – Improvised Nuclear Device

• RDD – Radiological Dispersal Device– may or may NOT involve explosion

• RED – Radiological Exposure Device A device whose purpose is to expose

people to radiation, rather than to disperse radioactive material. “silent source”

Population MonitoringPopulation Monitoring

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

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

Population MonitoringPopulation Monitoring

Evaluate potentially-affected population for:

– Needed medical treatment (both rad and non-rad related)

– Presence of contamination on body or clothing.– Intake of radioactive materials– Removal of external or internal contamination

(decontamination)– Radiation dose received and the resulting health

risk from the exposure– Long-term health effects (registry)

Evaluate potentially-affected population for:

– Needed medical treatment (both rad and non-rad related)

– Presence of contamination on body or clothing.– Intake of radioactive materials– Removal of external or internal contamination

(decontamination)– Radiation dose received and the resulting health

risk from the exposure– Long-term health effects (registry)

Potential ImpactsPotential Impacts

• Nuclear Detonation– Hundreds of thousands of fatalities– Hundreds of thousands contaminated

• Explosive Radiological Dispersal Device– Hundreds of fatalities– Thousands contaminated

• Nuclear Detonation– Hundreds of thousands of fatalities– Hundreds of thousands contaminated

• Explosive Radiological Dispersal Device– Hundreds of fatalities– Thousands contaminated

American Red Cross Sheltering/Contamination Issues

American Red Cross Sheltering/Contamination Issues

During the TOPOFF 2 exercise in Seattle, WA in 2003…

“Before evacuated residents could enter the shelter, they first had to be examined for radioactive material”

http://www.redcross.org/article/0,1072,0_332_1153,00.html

During the TOPOFF 2 exercise in Seattle, WA in 2003…

“Before evacuated residents could enter the shelter, they first had to be examined for radioactive material”

http://www.redcross.org/article/0,1072,0_332_1153,00.html

Citizens Have Radiation Monitoring InstrumentsCitizens Have Radiation Monitoring Instruments

Current Planning GuidanceCurrent Planning Guidance

The Federal Emergency Management Agency has exercise evaluation criteria requiring that state emergency response plans demonstrate the ability to monitor 20% of the potentially exposed population within 12 hours upon arrival at a relocation center.

Reference: “Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness in support of Nuclear Power Plants” NUREG-0645 FEMA-REP-1 Rev 11)

The Federal Emergency Management Agency has exercise evaluation criteria requiring that state emergency response plans demonstrate the ability to monitor 20% of the potentially exposed population within 12 hours upon arrival at a relocation center.

Reference: “Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness in support of Nuclear Power Plants” NUREG-0645 FEMA-REP-1 Rev 11)

How is this demonstrated?How is this demonstrated?For nuclear power facilities, affected populations could range from a few hundred to several hundred thousand individuals. Most state and local health departments attempt to demonstrate this with:

– Hand-held radiation survey instruments– Portal monitors (for only beta/gamma

monitoring) are used by only a handful of state agencies (the DOE has 13 deployable with the FRMAC assets)

– Alpha portal monitors have limited capabilities and are not easily transportable

For nuclear power facilities, affected populations could range from a few hundred to several hundred thousand individuals. Most state and local health departments attempt to demonstrate this with:

– Hand-held radiation survey instruments– Portal monitors (for only beta/gamma

monitoring) are used by only a handful of state agencies (the DOE has 13 deployable with the FRMAC assets)

– Alpha portal monitors have limited capabilities and are not easily transportable

External only

National Response Framework

Nuclear/Radiological Incident Annex



Decontamination/Population Monitoring are:

“the responsibility of State, local, and tribal governments.”

Decontamination/Population Monitoring are:

“the responsibility of State, local, and tribal governments.”

HHS, through ESF #8 and in consultation with the coordinating agency, coordinates Federal support for external monitoring of people and decontamination.– Department of Energy responsible for

equipment and personnel

HHS, through ESF #8 and in consultation with the coordinating agency, coordinates Federal support for external monitoring of people and decontamination.– Department of Energy responsible for

equipment and personnel





HHS assists and supports State, local, and tribal governments in performing monitoring for internal contamination and administering available pharmaceuticals for internal decontamination, as deemed necessary by State health officials.

HHS assists and supports State, local, and tribal governments in performing monitoring for internal contamination and administering available pharmaceuticals for internal decontamination, as deemed necessary by State health officials.





HHS assists local and State health departments in establishing a registry of potentially exposed individuals, performing dose reconstruction, and conducting long-term monitoring of this population for potential long-term health effects.

HHS assists local and State health departments in establishing a registry of potentially exposed individuals, performing dose reconstruction, and conducting long-term monitoring of this population for potential long-term health effects.





Current State/Federal Capabilities*Current State/Federal Capabilities*

• External monitoring

• Internal monitoring

• Bioassay

• Biodosimetry

• External monitoring

• Internal monitoring

• Bioassay

• Biodosimetry

Marginal

Extremely limited

*States with nuclear power plants somewhat better prepared.

CDC’s Approach to Nuclear/Radiological Preparedness

CDC’s Approach to Nuclear/Radiological Preparedness

• Determine what State, tribal and local public health agencies need

• Develop and test products that address those needs

• Prepare to successfully implement CDC’s responsibilities to support State, tribal and local officials

• Determine what State, tribal and local public health agencies need

• Develop and test products that address those needs

• Prepare to successfully implement CDC’s responsibilities to support State, tribal and local officials

CDC Efforts to DateCDC Efforts to Date• January 2005 – Population Monitoring

RoundtableSeptember 2005 – Roundtable Report Posted

http://emergency.cdc.gov/radiation

• March 2006 –Satellite broadcast

“Preparing for Radiological Population Monitoring and Decontamination”

• August 2007 - CDC posted draft population monitoring guidance based on input from a number of sources

• CDC is currently developing rapid radioanalytical laboratory capacity

• January 2005 – Population Monitoring RoundtableSeptember 2005 – Roundtable Report Posted


• March 2006 –Satellite broadcast

“Preparing for Radiological Population Monitoring and Decontamination”

• August 2007 - CDC posted draft population monitoring guidance based on input from a number of sources

• CDC is currently developing rapid radioanalytical laboratory capacity

Laboratory AnalysesLaboratory Analyses• Conventional methodology

– 24-hr urine sample– 3-7 days turnaround time– 5-40 samples/day/lab

• Improved methodology (for population screening)– 1-50 ml “spot” sample– 4-36 hours turnaround time (multiple radionuclides)– 100-500+ samples/day/lab

• Field screening and prioritization important• Increase number of public health laboratories

capable of doing such analyses

• Conventional methodology– 24-hr urine sample– 3-7 days turnaround time– 5-40 samples/day/lab

• Improved methodology (for population screening)– 1-50 ml “spot” sample– 4-36 hours turnaround time (multiple radionuclides)– 100-500+ samples/day/lab

• Field screening and prioritization important• Increase number of public health laboratories

capable of doing such analyses

Radiation Instruments in Hospitals

Radiation Instruments in Hospitals

To screen patients for internal contamination– Thyroid Scanners

• Feasible and practical

– Gamma Cameras• Not for large numbers

To screen patients for internal contamination– Thyroid Scanners

• Feasible and practical

– Gamma Cameras• Not for large numbers

An Evaluation of Hospital Radiation Detectors for Use in Screening Potentially Contaminated Individuals


• Target audience:– State and local public

health and emergency preparedness personnel

• Focus– Incidents involving

mass casualties

• Scope– Assumes local

infrastructure is intact– Principles apply to all

radiation incidents

• Target audience:– State and local public

health and emergency preparedness personnel

• Focus– Incidents involving

mass casualties

• Scope– Assumes local

infrastructure is intact– Principles apply to all

radiation incidents

CDC GuidanceCDC Guidance

PurposePurpose

• State/local emergency response and public health authorities can use this Guide to:– Evaluate their emergency response plans– Identify/prioritize staffing needs, training

requirements, and necessary material assets.

– Further develop mutual assistance programs– Be better prepared to prioritize allocation of

existing resources in actual response

• State/local emergency response and public health authorities can use this Guide to:– Evaluate their emergency response plans– Identify/prioritize staffing needs, training

requirements, and necessary material assets.

– Further develop mutual assistance programs– Be better prepared to prioritize allocation of

existing resources in actual response

Guiding PrinciplesGuiding Principles

• The first priority is to save lives: respond to and treat the injured first.

• Contamination with radioactive materials is not immediately life-threatening.

• Initial population monitoring activities should focus on preventing acute radiation health effects. – Cross contamination issues are a secondary

concern

• The first priority is to save lives: respond to and treat the injured first.

• Contamination with radioactive materials is not immediately life-threatening.

• Initial population monitoring activities should focus on preventing acute radiation health effects. – Cross contamination issues are a secondary

concern

Guiding Principles (CONT.)Guiding Principles (CONT.)

• Scalability and flexibility are an important part of the planning process.

• The State radiation control program is a key resource for implementing the plans outlined in this guide.– Establish relationships with other

radiation experts/resources in the community (hospitals, universities, etc.)

• Scalability and flexibility are an important part of the planning process.

• The State radiation control program is a key resource for implementing the plans outlined in this guide.– Establish relationships with other

radiation experts/resources in the community (hospitals, universities, etc.)

Current StatusCurrent Status

• Population Monitoring Planner Guide available from:


• Draft for comment

• Your feedback would be appreciated!!

• Population Monitoring Planner Guide available from:


• Draft for comment

• Your feedback would be appreciated!!

Community Reception CentersCommunity Reception Centers

• Local response strategy for conducting population Monitoring

• Multi-agency effort, public health lead

• Staffed by government officials and organized volunteers

• Opened 24-48 hours post event

• Located outside of “hot zone”

• Local response strategy for conducting population Monitoring

• Multi-agency effort, public health lead

• Staffed by government officials and organized volunteers

• Opened 24-48 hours post event

• Located outside of “hot zone”

Community Reception CentersCommunity Reception Centers

• Services include:– Screening for radioactive contamination– Assistance with decontamination– Limited medical care

• Prioritize people for further care– Ease burden on hospitals– Manage scarce medical resources

• Comparable to– Neighborhood Emergency Help Centers (NEHC) or– Point of Dispensing (POD)

• Services include:– Screening for radioactive contamination– Assistance with decontamination– Limited medical care

• Prioritize people for further care– Ease burden on hospitals– Manage scarce medical resources

• Comparable to– Neighborhood Emergency Help Centers (NEHC) or– Point of Dispensing (POD)

Community Reception Center Process Flow

Community Reception Center Process Flow

• 6 Main Process Areas– Initial Sorting– Emergency Medical

Care or Transfer– Survey and

Monitoring – Wash Station– Registration and

Dose/Medical Assessment

– Discharge

• 6 Main Process Areas– Initial Sorting– Emergency Medical

Care or Transfer– Survey and

Monitoring – Wash Station– Registration and

Dose/Medical Assessment

– Discharge

CRC Process Flow

CRC Process Flow

• Process can be adjusted to meet existing capabilities – Instrumentation– Personnel

• There is an “express” lane for people who have cleaned at home.

• There is an additional module for a “pet-friendly” reception center.

• Other processes can be added as needed or as possible– e.g., relocation services

• Process can be adjusted to meet existing capabilities – Instrumentation– Personnel

• There is an “express” lane for people who have cleaned at home.

• There is an additional module for a “pet-friendly” reception center.

• Other processes can be added as needed or as possible– e.g., relocation services

Work in ProgressWork in Progress• CRC-STEP

– Community Reception Center Simulation Tool for Evaluation and Planning

– Excel-based interface for modeling staffing and equipment resources and evaluating throughput.

• RealOpt-CRC– Optimization tool for maximizing throughput

• Both decision tools are easy to use

• User Manuals for both along with short tutorial video on the web will be prepared.

• CRC-STEP– Community Reception Center Simulation Tool for

Evaluation and Planning – Excel-based interface for modeling staffing and

equipment resources and evaluating throughput.

• RealOpt-CRC– Optimization tool for maximizing throughput

• Both decision tools are easy to use

• User Manuals for both along with short tutorial video on the web will be prepared.

CRC-STEPSimulation Tool for Evaluation and Planning

CRC-STEPSimulation Tool for Evaluation and Planning

• Excel Interface

• Customizable for Basic and Advanced Users

• Runtime Animation

• Excel Interface

• Customizable for Basic and Advanced Users

• Runtime Animation

RealOpt CRCOptimization Software

RealOpt CRCOptimization Software

• Free, no runtime license required.• Free, no runtime license required.

Work Just BegunWork Just BegunWeb-based training tool on CRC operations with detailed accompanying documentation and resourcesWeb-based training tool on CRC operations with detailed accompanying documentation and resources

Challenge:Adequate staffing for CRC

Challenge:Adequate staffing for CRC

• Motivate the country’s large health physics, medical physics, and nuclear medicine community to enlist in a locally-sponsored volunteer registry.

• CDC is leading a nationwide effort to organize radiation professional volunteers into existing health volunteer registries.

• Motivate the country’s large health physics, medical physics, and nuclear medicine community to enlist in a locally-sponsored volunteer registry.

• CDC is leading a nationwide effort to organize radiation professional volunteers into existing health volunteer registries.

Radiation Response Volunteer RoundtableFebruary 10-11, 2009, Atlanta, GA

Radiation Response Volunteer RoundtableFebruary 10-11, 2009, Atlanta, GA

• Invitees included representatives from:– ESAR-VHP (Emergency System for the Advance Registration of

Volunteer Health Professionals)– MRC (Medical Reserve Corps)– Professional societies:

• HPS, NRRPT, AAPM, SNM, ASTRO

– CRCPD– Several state health and EM organizations involved in radiation

volunteer registries

• Attendees developed an action plan for establishing roles and training requirements for radiation protection volunteers who could be used for population monitoring for large-scale events in the United States.

• Invitees included representatives from:– ESAR-VHP (Emergency System for the Advance Registration of

Volunteer Health Professionals)– MRC (Medical Reserve Corps)– Professional societies:

• HPS, NRRPT, AAPM, SNM, ASTRO

– CRCPD– Several state health and EM organizations involved in radiation

volunteer registries

• Attendees developed an action plan for establishing roles and training requirements for radiation protection volunteers who could be used for population monitoring for large-scale events in the United States.

SummarySummary

• “All emergencies are local”• Future terrorist events cannot

be dismissed• These events may involve

radiological components• Population monitoring will be a

key component in the public health response to any such event

• “All emergencies are local”• Future terrorist events cannot

be dismissed• These events may involve

radiological components• Population monitoring will be a

key component in the public health response to any such event

Radiation Studies Branch, CDC

[email protected]

(770) 488-3800

Charles W. Miller

770-488-3725

[email protected]

Radiation Studies Branch, CDC

[email protected]

(770) 488-3800

Charles W. Miller

770-488-3725

[email protected]

THANK YOUTHANK YOUhttp://emergency.cdc.gov/radiation

Documents

An Update on Population Monitoring Activities at CDC Charles W. Miller, PhD Armin Ansari, PhD, CHP Radiation Studies Branch Division of Environmental Hazards