1. OREGON PUBLIC HEALTH DIVISION Office of Environmental Public Health Radiation Emergency Preparedness and Response Capabilities in State Health Departments 2010 CSTE Survey for National Alliance for Radiation Readiness Michael A. Heumann, MPH, MA Oregon Public Health Division Office of Environmental Public Health

2. Background No measure of state readiness to respond to radiation incidents. Council of State & Territorial Epidemiologists (CSTE) surveyed state health agencies in collaboration with NARR. CSTE Report (http://www.cste.org/webpdfs/2010raditionreport.pdf) Sent to CDC, DHHS, DHS Published in J. of Disaster Med & PH Preparedness 2

3. Scope of Survey Assess the nation’s overall preparedness and response capabilities regarding radiation emergencies. Assess preparedness activities for all radiation response, not just terrorism. –Compare states with nuclear power plants and those without 3

4. Survey Methods Organization : Planning and Resources. Radiation Emergency Staffing Levels in States. Local Relationships. Inter- and Intra-agency Coordination. 4

5. Survey Methods Sent to State Epidemiologist. Asked that other relevant offices and state expertise contribute: –Radiation Program –PHEP program –PH Lab –Environmental PH 5

6. Who responded? 38 states (76%) 26 of 31 states with nuclear power plants (NPP) (84%) 12 of 19 states without NPP (63%) 6

7. Survey Results: Planning and Exercising 53% have finalized radiological written response plans. –80% of the states with a written plan had exercised. –44% of these, > 1 year ago. Most reported mutual aid relationships with other states or other agencies. –Some responders did not know. Most states (97%) have on call 24/7 covera ge. 7

8. Survey Results: Extent of Planning I---------------------------I I---------I I------------------------I I-------------------I 8

9. Survey Results: Resources Available 9

10. Radiation Incident Response Staffing Staff by NPP 10 Staff in FTE n=28

11. Survey Results: Inter / Intra-Agency Coordination 11

12. Survey Results: Coordination Gaps 55% report that teams do meet with other parts of health department. 29% report that radiation response team is not in the state health agency. 50% of states without a NPP report that the team is not located in the state health agency. Most states had no protocols for gathering epidemiologic and exposure data and some did not know. 12

13. Overall Radiation Readiness 13

14. Survey Conclusions In nearly every measure of public health capacity and capability the nation is poorly prepared to respond to a major radiation event. Capabilities were insufficient throughout sections related to planning, resources, relationships. Fundamental step of preparedness: development of response plans has not occurred in 45% of responding states. Better response for dirty bomb scenario, for on-call coverage, communications, and mutual aid agreements. 14

15. Recommendations Collect and disseminate best practices in state-based radiation response plans including coordination with NARR, and with CSTE Disaster Epi workgroup for development of plans and guidelines for surveillance. Explore with CDC how to incorporate radiation preparedness as a priority in all hazards capabilities development. 15

16. Recommendations Increase training in radiation emergency response for public health personnel. Coordinate with ASPR at federal level and ASPR- funded state public health programs on building radiological response capabilities. Promote strategic planning between state PHEP and traditional radiation personnel to increase collaboration. Develop exercise templates for non-NPP scenarios. 16

17. Acknowledgements Authors: Michael Heumann, Sharon M. Watkins, Dennis M. Perotta, Martha Stanbury, Henry Anderson,Erin Simms CSTE, Monica Huang, Jennifer Lemmings, and Patrick McConnon. Thanks to the CSTE Radiation Emergency Workgroup members for offering their time and expertise in drafting this assessment. Representatives from state health departments, the Conference of Radiation Control Program Directors, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and CDC collaborated on this project. CSTE greatly appreciates and acknowledges the thoughtful input provided by all respondents. The Council of State and Territorial Epidemiologists (CSTE) conducted this assessment with financial support from the Association of State and Territorial Health Officials (ASTHO) and the Centers for Disease Control and Prevention (CDC) (Cooperative Agreement 1U38HM000454). 17

18. Disclaimer The views and opinions expressed in this document are solely those of the CSTE Workgroup, unless otherwise indicated, and may not necessarily represent the views and opinions of the member associations of the National Alliance for Radiation Readiness or the CDC. Although the information in this document may be used by CDC to develop effective public health guidance and guide future actions, any statements made or actions taken in response to this report does not necessarily constitute endorsement or agreement by the CDC or the National Alliance for Radiation Readiness of the findings, conclusions, and recommendations contained in this document. 18