Public health response to a radiological accident: a guide for state and local public health departments




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public health response to a radiological accident: a guide for state and local public health departments

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PUBLIC HEALTH RESPONSE TO RADIOLOGICAL ACCIDENTS:

A Guide for State and Local Public Health Departments


Developed by the Radiation Studies Branch

Division of Environmental Hazards and Health Effects

National Center for Environmental Health

Centers for Disease Control and Prevention

US Department of Health and Human Services

January 2010


PREDECISIONAL DRAFT


This planning guide is provided as a predecisional draft. Please send your comments and suggestions to the Radiation Studies Branch at CDC via e-mail (rsb@cdc.gov) or mail them to:


Radiation Studies Branch

Division of Environmental Hazards and Health Effects

National Center for Environmental Health

Centers for Disease Control and Prevention

1600 Clifton Rd, NE (MS-E39)

Atlanta GA 30333


Table of Contents


Introduction


Overview: What is a Radiological Accident?


How is a Radiological Accident Unique?


What Role Does Public Health Have in Response to a Radiological Accident?


What Needs to be Done Following a Radiological Accident?


What Resources are Available for Response to a Radiological Accident?


How Do I Prepare for a Radiological Accident?


What Resources are Available for Planning for a Radiological Accident?


What Should I Remember About a Radiological Accident?


Appendices


1 – Actual Radiological Accidents


2 – Radiation Hazards and Medical Management of Radiation Victims


3 – References


4 – List of Acronyms


5 – Glossary


Introduction


A highly radioactive teletherapy source, abandoned by a clinic in a large city, is stolen and pried open. It is then sold to junk dealers for scrap. Inside is a beautiful, glittery blue powder. A little girl in the junk dealer’s house plays with the powder, spreading it on her face and eating it. Others in the house play with the powder as well. Two weeks later, the junkyard owner’s wife, concerned about some of the symptoms her family are exhibiting, takes a bag of the blue powder with her on a bus to a doctor’s office at the local health department. Initially, the diagnosis is a tropical disease, and some of the affected individuals are sent to the tropical disease hospital. After some consultation, one of the involved physicians suspects radiation poisoning and alerts a physicist he knows, from the national radiation control authority. By the time the physicist confirms the presence of radiation, the material has been spread over a large area, primarily in low-income neighborhoods where many residents are poorly educated or even illiterate. Dozens are hospitalized, more than a hundred thousand demand to be monitored, and four people ultimately die, including the little girl – whose body must be buried in a lead coffin sealed in concrete. Public information is scant at first, and the population is terrified. The economy of the area is dealt a serious blow. The cleanup takes several months in sweltering heat and humidity. (See Appendix 1 for a more detailed account of this incident.)


A former intelligence agent, after having dinner with colleagues at a hotel bar, suddenly falls ill and is hospitalized. Only in his last hours of life, just a few weeks later, do officials find that he has been poisoned with radioactive material. Investigators find traces of the material in the hotel bar, in the agent’s home, and in other places he visited before going to the hospital. Everyone who has been in that hotel, or who has been anywhere near the agent in the last few weeks, is potentially contaminated as well. This includes passengers on an international flight, guests at the hotel, and local residents. All of them have to be tracked down, interviewed, and directed where to go for the appropriate tests – once the officials actually find a lab that can do the tests, which itself takes a long time. Some 3000 people are ultimately interviewed. Once this hits the news, hundreds of private individuals call in to the national public health agency, fearful that they have been contaminated and wanting to be tested. The hotel bar is closed and the agent’s house is sealed, so that his widow cannot return to her home. Only the agent dies, but several dozen individuals are found to have elevated levels of the radioactive material in their urine. (See Appendix 1 for a more detailed account of this incident.)


A group of political dissidents buries a package containing radioactive material and explosives in a public park. Fortunately, the leader alerts a local television crew, and the package is quickly located before the device can be detonated.


Authorities arrest two men on charges of plotting against local officials. A search reveals canisters of radioactive material, which the suspects intended to spread in their victims’ cars and introduce into items such as food and toothpaste.


These may sound like excerpts from spy novels, but they are just a few of the many radiological incidents that have taken place over the last few decades. All four actually occurred (Goiânia, Brazil; London, England; Moscow, Russia; and Long Island, New York); fortunately, the last two were thwarted before they could have serious public health consequences. With increasing international tensions, and all-too-easy access to radioactive materials, it can happen here. It can happen in your area. Your citizens can be at risk. You need to be prepared to protect their health and safety, as well as that of the emergency responders.


This guide is intended to help you, as a public health official, prepare yourself and your agency to respond quickly and effectively to a radiological incident. It will outline the things you need to be ready to do, the steps you need to take to be ready to do them, and the many resources you can draw on.


You must prepare for these incidents, but you don’t have to do it alone. Many public health agencies at the state and local levels have done considerable planning for radiological emergencies, and have recorded their successes and failures for others to learn from, in widely accessible reports, presentations, and training materials. This manual will list many of these references.


Fortunately, much of what you need to do to prepare to respond to radiological accidents is similar to what you are doing, or have already done, to prepare for pandemic flu, bioterrorism, and other public health threats. Planning efforts for all these events need to be coordinated closely – which means that not only do you not need to, but you must not, reinvent wheels.


We hope this guide will help you discover how to use your resources in the most effective and efficient manner to prepare for a radiological accident. We also hope that you will realize there is a wealth of information and support for your efforts. Please feel free to contact any of the agencies listed in this guide. And if you have a success story of your own, please share it with the public health community. The information you share might help someone else save a life in an emergency.


CDC

Section 1 - Overview: What is a Radiological Accident?


Radioactive materials are in wide use in our society and throughout the world. They are used to diagnose and treat medical conditions, assist in manufacturing, testing, and construction, provide electric power, sterilize medical supplies and foodstuffs, perform scientific research, and enable consumer goods such as smoke detectors.


Like many other things, such as fire, electricity, and chemicals, radioactive materials present a hazard if they are improperly used, stored, or transported. See Appendix 2 for a more detailed discussion of the hazards. Radioactive materials can be used, deliberately or accidentally, to cause harm to individuals through exposure (like feeling the heat from a fire) or through contamination (like getting the hot ashes or cinders on your skin, or inside your body). This could happen in a number of ways:


  • Radioactive material could be accidentally spilled or a container opened during use or transport. It could end up on the hair, skin, or clothing of people nearby, or inhaled into their lungs.




  • A conventional explosive could be attached to any radioactive material. When the explosive was detonated, the material would be dispersed in the immediate area. This is the classic “dirty bomb” scenario (sometimes called a “radiological dispersal device,” or RDD). Victims could suffer blast injuries and have radioactive material on their hair, skin, or clothing. They could also inhale radioactive material along with dust and airborne debris. The injured could have radioactive material in their wounds. The priority would be to treat their injuries and check for radioactive contamination. Material on their skin, hair, or clothing could be removed easily. Material taken into the body would require more complex evaluation and treatment to remove. The radiation hazard would probably be small compared to the effects from the explosive, but the possibility that an area could be contaminated would cause major fear and economic disruption.




  • Disaffected persons could fashion and detonate an improvised nuclear device (IND) or crude atomic bomb. Depending on the sophistication of the technology used, this could result in high exposures and widespread contamination, as well as fatalities. This is also thought to be the least likely among the various types of radiological accident. Survivors in the immediate vicinity would have blast injuries, thermal burns, and high radiation exposures. After the explosion, fallout would settle in the area, and downwind sectors would become highly contaminated. People in the affected areas would need to bathe and remove contaminated clothing, and avoid inhaling the fallout material. Evacuees, and those requiring medical attention, might travel or be transported hundreds or even thousands of miles.




  • Radioactive materials could be used deliberately to contaminate a water supply, a food source, or a ventilation system in a large building. Victims of this scenario could unknowingly drink, eat, or inhale radioactive material. Unless the event were announced, there would be no way to know that radioactive material had been used. Once radiation was suspected or confirmed, victims’ urine and other fluids would need to be sampled. Medical providers would need to consult with radiation experts to determine the extent of the injury and the appropriate treatment to remove the material from the body. As with a dirty bomb, it might be difficult to cause serious radiation-related injury, but again, the possibility of contamination over a large area could be psychologically and economically devastating.




  • A radioactive source could be deliberately or accidentally left in an area where people could receive potentially significant radiation dose. (This is sometimes referred to as a “radiological exposure device,” or RED.) Victims of the exposure scenario could receive significant whole-body or individual body part exposures. They would not have radioactive material on or in their bodies, so they could not be checked by traditional monitoring methods. As with the contamination scenario above, there would be no way initially to know that a radioactive source was involved, unless a radiation monitor happened to be in the area where the source was placed. The symptoms of high whole-body exposure mimic those of flu or other related diseases (see the discussions of Acute Radiation Syndrome in Section 3 and Appendix 2); a correct diagnosis is unlikely without the right tests. High exposures to a foot, hand, or other individual body part could cause damage including erythema, blistering, peeling, depilation, and ulceration. Early treatment would be similar to that for severe burns.



The health effects observed from each of these scenarios would depend not only upon how much total radiation dose was received, but also how quickly. In some cases, the radiation hazard would be much less of a concern than the other injuries. In addition to the physical effects, all these scenarios would result in the fear, anxiety, stress, and other symptoms commonly seen during disasters. Citizens would look to the public health department to help them deal with both the physical and psychological effects.


How a radiological accident is recognized depends on the scenario, and whether the event is overt or covert.


Overt event


Following an explosion, spill, or other well-defined event, the immediate need would be to determine how severe the radiation hazard is, and which radioactive materials are involved. Radiation experts would need to monitor the area with special instruments to make this determination. An overt event would evolve like other hazardous materials accidents.


Covert event


A covert event (an exposed radiation source, or deliberate or accidental contamination) might not be identified unless and until someone recognized patients’ symptoms as possibly caused by radiation exposure, and secured the appropriate tests. This kind of event would evolve like a disease outbreak – one in which the “disease’s” symptoms mimic those of flu and other conditions. As with any public health threat, rapid identification is critical to rapid and effective response.


SIDEBAR: Recognition of a problem


Since the ability to recognize any outbreak depends in part on the ability to recognize an abnormal rate of occurrence of symptoms, the “syndromic surveillance” systems instituted as part of pandemic flu or bioterrorism preparedness may prove useful in helping to identify radiation exposure or contamination.


Since radiation exposure mimics symptoms of other diseases, it may be difficult to discriminate between accident-related and “normal” incidence of symptoms. In an attempt to clarify this situation, Santa Clara County (CA) set up a tool to determine the “baseline” for symptoms such as nausea, vomiting, etc. Each nurse in a hospital emergency room fills out a one-page form for each patient and faxes it to the health department. Over two years, the department has been able to establish a reliable baseline for an array of symptoms, so that any abnormality can be quickly recognized.


Section 2 – How is a Radiological Accident Unique?


Radiological accidents may be similar in many respects to other hazardous materials accidents, or to disease outbreaks, depending on the accident scenario. Nevertheless, despite these similarities, it is crucial to recognize how radiological emergencies differ from other threats:


  • Radioactive material cannot be detected with human senses, only with special instruments. Symptoms of severe radiation exposure or contamination mimic those of other ailments, and without radiation surveys or special tests there is no way to determine beyond a doubt that radiation is the cause of a particular symptom. Fortunately, radiation instruments are readily available and generally reliable when used properly, and radiation is one of the most thoroughly studied and best understood health hazards.




  • Subject matter experts in radiation may or may not be part of a department of public health (and seldom are at the local level). Compared to the medical community, the number of individuals in this country knowledgeable about radiation is relatively small. You need to work closely with your state radiological health staff to ensure you will be able to get the technical information you will need.




  • Medical care of victims can be complicated by the presence of radioactive exposure or contamination. Nevertheless, lifesaving medical treatment must always take precedence over concerns about contamination. Medical treatment for high radiation exposures primarily addresses the symptoms; internal radioactive contamination can be treated by certain drugs that remove the material from the body.




  • Laboratory capability to identify radioactive materials, especially in human tissue/fluid samples, is scarce. It will be necessary to work with your state radiation control program, and with the CDC, to identify labs that can provide timely sample analysis results.




  • Radiation cannot be neutralized or disinfected. In order to remove the threat, the material itself must be removed.




  • Unlike some biological and chemical agents, radioactive material on or in a patient generally presents very little hazard to others, especially if caregivers follow universal precautions.




  • Radiation, unlike flu, is not contagious.




  • In general, the public fears radiation far more than it does other threats, and many people believe that any amount of radiation is dangerous. This fear can seriously hamper response and recovery efforts and must be dealt with. Because radiation cannot be detected by human senses, a radiological accident may raise the fear of the unknown and make people feel as if they are helpless to protect themselves, even if they have been instructed beforehand.




  • Many people automatically associate radiation with the atomic bombs used during World War II. Publications and messages should carefully point out this distinction.




  • Unlike some other hazards, radiation is a normal part of our everyday environment. Not only is there a “background” level of radiation exposure present in our environment, but the use of radioactive materials is widespread throughout the country and the world.




  • Responses to the few radiation accidents that are well known (such as the accident at the Three Mile Island nuclear power plant in 1979) have not always been marked by well-coordinated and complete public information, so the public and the media are extremely skeptical.


Section 3-What Role Does Public Health Have in Response to a Radiological Accident?


As with many other types of incidents, the public health community has a number of roles to play and functions to perform in response to a radiological accident, including:


  • Ensure the provision of medical services




  • Help protect the health and safety of emergency responders




  • Monitor short-term health effects on the population and emergency responders




  • Perform surveillance on the population and responders for long-term effects




  • Assist in assessing and responding to the environmental contamination threat




  • Ensure the provision of mental health and counseling services




  • Provide accurate, timely public information




  • Coordinate with other responding agencies


Each of these roles and functions will be discussed in more detail in the next section.


These roles and functions are not new. They are the same kinds of things you would need to do in other types of public health threats, particularly involving any kind of hazardous materials. All of these functions fall within the ten “Essential Public Health Services” defined by CDC under its National Public Health Performance Standards Program (http://www.cdc.gov/od/ocphp/nphpsp/essentialphservices.htm, and http://www.rand.org/pubs/technical_reports/2009/RAND_TR719.pdf, both last accessed 1/2/2010).


The role you do NOT have to play is that of radiation expert. That role will be filled by your state radiation control staff, or by local radiation experts identified during the planning process, or by Federal officials called in to assist. These people will be able to give you the information you need to fulfill your roles.


Regardless of the type of accident, there is a great deal that you can do to assist victims, help responders, protect the environment, and inform the public. Your citizens will view you as a protector of health and safety. You need to be ready.

Section 4 –What Needs to be Done Following a Radiological Accident?


ENSURE THE PROVISION OF MEDICAL SERVICES


Medical services will be a major part of response to a radiological accident. Following an explosion, surge capacity will be needed to treat burns, blast injuries, cuts, broken bones, smoke inhalation, and radiation exposure or contamination. If large numbers of people are affected, victims may need to be moved to other medical facilities, even at some distance away. Shelter and mass care will need to be provided to those evacuated or unable to return home. Shelters and mass care centers will need to be monitored to control the spread of infectious disease and to manage any pre-existing conditions of those in the facility. Care may need to extend to animals. Although the accident itself may be localized, the effects will be felt throughout the nation’s health care system. People from the affected areas may flee great distances, even across the country.


HELP PROTECT THE HEALTH AND SAFETY OF EMERGENCY RESPONDERS


The Federal government has set guidelines for how much radiation exposure responders should be allowed to receive. These limits are far below the levels known to cause harm. Responders’ exposures should be monitored and tracked to minimize the risks.


To keep responders’ exposures low:


  • Once an area is known to be high-exposure, or has been identified as close to an accident location, spread out assignments in that area among many responders.




  • Monitor exposures. This may be done with dosimeters (special instruments that measure radiation exposure). Some dosimeters can be read by the person wearing them, while others require special processing. Responders who can read their own dosimeters need to do so, and communicate their readings, regularly. Also keep track of how much time responders spend in which areas. This will help radiation experts estimate exposures.




  • Give priority to responders for any prophylaxis or treatment recommended by radiation experts.


Responders can also take actions to protect themselves. They should always assume that radiological, chemical, and biological hazards may all be present in a situation, until monitoring and testing can confirm one way or the other.


In an accident involving dispersed radioactive material – such as a spill or a dirty bomb – the priority is to avoid getting the material into the body. It is easier to keep the material out than to remove it later. There are three pathways to focus on:


  • Inhalation: avoid breathing in radioactive material. Wearing a mask, or even covering the mouth and nose with a handkerchief or other article of clothing, can prevent inhalation of radioactive material.




  • Ingestion: avoid eating, drinking, or smoking in an area where radioactive material is present in the air or on the ground.




  • Absorption: radioactive material may be absorbed into the body through breaks in the skin. Ensure that any wounds are well covered.



In an accident involving high exposures, responders can protect themselves using time, distance, and shielding:


  • Time: minimize the time you spend near a radioactive source.




  • Distance: increase the distance between yourself and a radiation source. If you move twice as far away from a source, your exposure rate drops to one-fourth its previous value, so distance is a powerful tool to reduce your exposure.




  • Shielding: place some kind of material between yourself and a radioactive source. The type and amount of shielding will depend on the kind of radiation emitted (see Appendix 2), so consult with radiation experts for advice.


In addition to radiation risks, responders may be subject to heat, cold, mechanical injury, biological or chemical agents, and psychological effects.


MONITOR SHORT-TERM HEALTH EFFECTS ON THE POPULATION AND RESPONSE WORKERS


The effects of radiation on human health are well-studied and documented, but distinguishing radiation-induced injury or illness from other types is not possible without the appropriate surveys or tests.


Following a radiological accident, members of the public and responders in any affected area will need to be examined and monitored for injuries, radioactive contamination, and radiation exposure. People near (or sometimes not so near) the affected area will also demand to be monitored – whether or not they try to leave the area. They will fear they have been contaminated or exposed. They will need to “prove” they are not contaminated so that they can stay in hotels or shelters, or so that they will not be shunned by others.

Monitoring for external contamination (radioactive material that has settled on the skin, hair, or clothing) usually involves hand-held or portal (walk-through) radiation instruments. Many states and some local governments have these instruments, especially those that have plans in place for response to nuclear power plant accidents. Check with your state radiological health staff to determine your state and local capability. The Federal government can also supply some equipment and personnel. Population monitoring is covered in much greater detail in a guidance document from the Centers for Disease Control and Prevention (CDC), Population Monitoring in Radiation Emergencies: A Guide for State and Local Public Health Planners. This document can be obtained from CDC in hard copy or downloaded from the CDC website (http://www.bt.cdc.gov/radiation/pdf/population-monitoring-guide.pdf, last accessed 1/2/2010).


Persons with external contamination should remove and bag clothing, shower and wash hair (keeping soap and shampoo out of eyes, ears, nose, and mouth, and taking care not to abrade skin), and then be monitored again. This simple process removes most, if not all, of the contamination. If monitors still indicate contamination after the shower, the person should be referred to medical personnel or radiation experts for further evaluation.


Radioactive material that has been taken into the body (internal contamination) may be able to be removed, depending on the material involved. Persons with internal contamination will need to be referred to a laboratory that can collect and analyze the samples and specimens necessary to evaluate exposures. Samples and specimens will need to be labeled, preserved, stored, and assigned appropriate priority for analysis. This may not be a trivial task.


Farm and companion animals may need to be monitored, and tracked as well, to reduce the threat to humans and to identify potential vector issues. Public health personnel will need to work with radiation, agricultural, and veterinary experts to monitor and care for animals.


If the accident involves high radiation exposures, this may result in a collection of symptoms commonly known as Acute Radiation Syndrome (see Appendix 2). It will be necessary to estimate exposure levels in order to triage and treat appropriately. There are several ways to estimate radiation exposure:


  • Time from exposure to onset of vomiting (and severity of vomiting) - the shorter the time, the greater the exposure. Unfortunately, vomiting may result from a number of different causes, including psychological ones, so vomiting alone is not a reliable estimator.

  • Lymphocyte depletion kinetics - how fast lymphocytes drop is a reliable indicator of radiation exposure.

  • Chromosome aberration cytogenetics - the number of dicentric chromosomes in peripheral lymphocytes is also a reliable marker, up to fairly high exposure levels.


Estimating exposures by lymphocyte depletion or chromosome aberration is a time-consuming and precise process. If time or resources do not permit this, then exposures can be roughly estimated if victims can provide information about how close they were to the source, or the explosion, and for how long.


Once exposures have been determined or estimated, appropriate treatments can be selected. Few general guidelines can be prescribed, but prevention and management of infection will be crucial. Patients receiving high exposures may also suffer bone marrow depletion and loss of intestinal mucosa. Much can be done to ensure the survival of even high radiation exposures, provided that they are diagnosed correctly and treated promptly.


See Appendix 2, and its references, for more details on medical management of radiation accidents.


PERFORM SURVEILLANCE ON THE POPULATION FOR LONG-TERM HEALTH EFFECTS


In the aftermath of a radiological accident, exposed and contaminated persons will need to be registered and tracked in order to determine the long-term health effects from the accident. Public health personnel will need to set up a system for registering everyone who presents to be monitored, both members of the public and responders. At a minimum, every individual should give his name, address, and contact information. The system should be flexible and should provide for recording both physical and psychological effects.


ASSIST IN ASSESSING AND RESPONDING TO THE ENVIRONMENTAL CONTAMINATION THREAT

Any radioactive material released into the air, or deliberately introduced into a public area in a dispersible form, will be carried by the wind and brought to the ground by rain or snow. It can settle on office buildings, restaurants, streets, animals, yards, crops, pastures, silos, dairies, food processing facilities, surface water supplies, water treatment plants, or anything else in the area. It will be necessary to determine as soon as possible which radioactive isotopes are involved and where they are expected to end up in the environment. Public health officials will need to work with other agencies’ experts to identify what is in the affected area and how radioactive contamination might affect it, in order to ensure the safety of food, water, and animal feed. The object is to prevent, if possible, the introduction of radioactive material into the human or animal food chain, or into the human body. How that can be accomplished depends primarily on what is released and how, what is in the affected area, and how the time of year or other factors affect how it will be dispersed. Close coordination with other agencies will be crucial.


One action that can be taken fairly early following an accident is to recommend that dairy animals be put on stored feed and water from covered sources. Another is to restrict certain food products from an area temporarily. Monitoring and sampling of products in the affected area will then be necessary in order to determine the extent and type of radioactive contamination. Following analysis of monitoring and sampling results, radiation experts can provide input on whether and when restrictions can be lifted.


Working closely with radiation experts, health departments will assist in providing instructions for decontamination and cleanup. They will also need to assist in advising on dealing with the deceased, and to identify and monitor other pathways for exposure/contamination, including issues of vector control.


If the event is deliberate, rather than accidental, law enforcement will have a strong presence in the response, and the area may have to be treated as a crime scene. Public health and other responding agencies will need to help law enforcement find and preserve evidence, such as clothing, personal articles, or debris.


ENSURE THE PROVISION OF MENTAL HEALTH AND COUNSELING SERVICES


Radioactive contamination of an area, or the presence of a radioactive source, whether actual or potential, will induce stress, fear, anger, helplessness, and all the physical and psychological effects that accompany them. This is one reason a dirty bomb or exposed radiation source is thought to be an effective “weapon of mass disruption;” the public’s fear of anything dealing with radiation will lead them to avoid any area or product even suspected to be contaminated. People who become exposed or contaminated may respond with rage as well as fear and may thwart the efforts of their caregivers to treat them. Responders may share the public’s fears and may react negatively to working in respirators or anti-contamination clothing.


Public health staff must include mental health professionals in both planning and response. Counseling will need to be available at monitoring centers, at medical facilities, at staging areas from which responders deploy, and in the affected community in general. In addition to the usual psychological responses to a disaster, the widespread fear of radiation may induce people to make drastic decisions, such as aborting a pregnancy, or to demand drugs they believe to be effective against “radiation poisoning.”


PROVIDE ACCURATE, TIMELY PUBLIC INFORMATION


The need for accurate and timely public information cannot be overemphasized. Health departments consistently rank as trusted sources for information, so they will need to be prepared. The public will likely be frightened and not easily directed or reassured. It will help if they have already received routine publications (fact sheets, brochures, etc.), giving them information about radiation and what to do following a radiological emergency. A strong public information campaign before and during an incident can help minimize uncertainty and chaos.


During response to an accident, health officials will need to do a number of things simultaneously:


  • conduct media briefings in coordination with other agencies

  • monitor media reports closely in order to address inaccuracies or emerging issues

  • set up rumor control hotlines, and provide scripts or outlines for staff

  • distribute pre-developed materials, such as fact sheets or brochures

  • set up a website, or update an existing one

  • keep careful records of all official releases

  • adjust the public information strategy as necessary


Flexibility will be important, as media will be everywhere, and all department staff will need to be trained in the department’s media policies.


Your public information program should have two components: an ongoing, routine component that informs people and establishes your credibility; and an emergency response component that trades on that credibility to lead the public to take the actions most needed to protect themselves. There is a wealth of guidance on how to set up effective public information programs.


See what public information materials are already available. Don’t reinvent wheels. If your jurisdiction already has some kind of fact sheet or brochure about bioterrorism, or pandemic flu, or other threat, consider expanding it to include radiological accidents – or at least pattern a radiological fact sheet after the existing one. People will feel more comfortable with established formats and will be able to find the information they need more quickly and easily.


Pre-script emergency messages. No, you won’t be able to capture every aspect of an emergency, and you may have to revise messages at the last minute, but it is much easier to revise a message in a crunch than to write a whole new one under pressure. Confer with your emergency management and radiological health experts; you may be able to use already existing messages as a template. If you don’t already have one, establish a policy regarding release of information and victim privacy rights – and make sure your staff are familiar with this policy.


In developing routine and emergency messages and scripts, make sure to coordinate with the mental health provider community. Following a radiological accident, psychological effects will likely be pronounced and widespread. Skillful use of public information will not allay all fears, but can go a long way to reassure the public and minimize panic.


As with everything else in a response, public information must be coordinated closely with other responder agencies. Your spokespeople will likely need to report to a Joint Information Center along with other organizations’ spokespeople. The overall response will be greatly helped by messages that supplement and reinforce, rather than contradict, each other.


COORDINATE WITH OTHER AGENCIES


Response to a radiological accident will likely involve local and state health departments, emergency management agencies, radiation control programs, Federal agencies, 911 and EMT networks, and private or non-governmental groups. Coordination will be crucial. An uncoordinated response is ineffective at best and counter-productive at worst.


Recognizing this, government agencies at all levels have organized their response activities with multi-agency coordination centers where agency representatives can work together to identify priorities, allocate resources, and communicate back to their own agencies. These may include:


  • Local and State Emergency Operations Centers (EOCs)

  • Joint Information Centers (JICs)

  • Unified Command


Review your state and local plans and become familiar with which agencies are represented at which locations during a response. If your agency is not already represented at one or more of these centers, be sure you know appropriate contacts at the centers where you can get the information you need. Communications and information systems must be adequate to handle this challenge.


In order to make coordination easier, the Federal government strongly encourages state and local agencies to adopt the Incident Command System (ICS) and the National Incident Management System (NIMS, http://www.fema.gov/emergency/nims/, last accessed 1/2/2010). Familiarity with the common terminology and organizational structures used in ICS and NIMS will be important in order to work effectively with other agencies.

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