1. 0 John F. Koerner, MPH, CIH Chief – CBRNE Branch Division of Preparedness Planning Office of Preparedness & Emergency Operations Public Health & Radiation Emergency Preparedness Conference March 2011 ESF#8 Tools for the Nuclear Response

2. The views and opinions expressed in this presentation are strictly that of the presenter and are not necessarily the views of ASPR, the Department of Health and Human Services, or the United States Government. No endorsement of products is implied.

3. CBRNE Branch MissionCBRNE Branch Mission 1.To provide health-related CBRNE subject matter and operational expertise across the spectrum of ASPR preparedness planning and response 2.To recognize, anticipate, and evaluate gaps in the Nation’s systems for medical and public health response to CBRNE events through cooperative professional interactions 3.Development of innovative, evidence-based interventions to strengthen the Nation’s medical and public health emergency response

4. Learning Objectives Introduce and describe evidence-based tools, systems and guidance – State/Local Planners Playbook for Medical Response to an IND – Radiological Emergency Medical Management (REMM) – MedMap – Rad-LN

5. Key principles - medical and public health response to nuclear detonation A partnership of SME’s from the Nuclear Detonation Scarce Resources Working Group Offered as a guide to link State, local, and ESF #8 planning –Web-based, interactive format or downloadable A living document - updated periodically – we want your comments Reference - Murrain-Hill P, Coleman CN, Hick JL, Redlener I, Weinstock DM, Koerner JF, Black D, Sanders M, Bader JL, Forsha J, Knebel AR. Medical Response to a Nuclear Detonation: Creating a Playbook for State and Local* Planners and Responders. Disaster Med Pub Health Prep. 2011.

6. “What do I do?”

7. Action Steps Sequential guidance to coordinate the medical response to a nuclear detonation Detailed time-phased, sector-oriented approaches to response activities with linked references. –General Readiness Planning and Emergency Management –Emergency Medical Services (EMS) –Health and Facility Response, Public Health –Medical System Response –Evacuee Medical Care and Fallout-related Illness –Recovery

8. Typical Action Screen

9. REMM Radiological Emergency Medical Management (REMM) –ASPR/NIH Managed –Collaboration – consultation with experts across the spectrum –Goals Provide guidance to healthcare workers regarding diagnosis and treatment Just-in-time, evidence based information to enhance understanding Web-based, multi-platform download –Updates iPhone App, Blackberry, Palm, and Windows mobile New videos, animations, and illustrations Updated models, tools, and algorithms Triage tool –http://www.remm.nlm.govhttp://www.remm.nlm.gov

10. REMM Basis –Casagrande R, Wills N, Kramer E, Sumner L, Mussante M, Kurinsky R, McGhee P, Katz L, Weinstock DM, Coleman CN. Using the Model Of Resource and Time-based Triage (MORTT) to Guide Scarce Resource Allocation in the Aftermath of a Nuclear Detonation. Disaster Med Pub Health Prep. 2011. –Coleman CN, Casagrande R, Hick JL, Weinstock DM, Bader JL, Chang F, Nemhauser JB, Knebel AR. Triage and Treatment Tools for Use in a Scarce Resources - Crisis Standards of Care Setting following a Nuclear Detonation. Disaster Med Pub Health Prep. 2011. Clinical Triage Tool

11. REMM Clinical estimation of dose from exposure

12. MedMap Integrated Approach to Decision Support Incorporates GIS and health-related databases from Federal and Private-sector sources (HSIP, FRMAC) Uses 8 or 10-point grid and validation (Fusion Cell) Can be updated at SOC or User level Rapid proof of concept – 3 months Demonstrable utility – Haiti –Updated damage image within 48 hours –Fusion did analysis damaged structures routes Improvised collection points –IRCT provided updates from user end

13. MedMap

15. Rad-LN Primary Objectives –Establish National Capability with International Co-operation –Deployable Laboratories –Core Laboratory Network: Cytogenetic and Radiobioassay Analysis –High Throughput Biodosimetry This is a developing concept and not an official project

16. Rad-LN 1. Radiobioassay – CDC Core Lab and other health physics labs (NIH Radiation Safety, nuclear medicine departments, state laboratories, and Canadian laboratories) 2. Cytogenetic biodosimetry – up to 500,000 samples - acute management and risk assessment 3. Hematology – CBC >100,000 per day. Novel approaches such as mobile laboratories. 4. Ongoing optimization and improvement of existing techniques 5. Surge capacity – for radiobioassay, biodosimetry, and sample tracking 6. Oversight committee – Standardization, exercise and assuring that there is a balanced investment 7. International collaboration

17. Triag e Dos e Esti mate Medi cal Mana gem ent Epidemio logy Radiobioassay Hematology Cytogenetic Biodosimetry Novel Molecular Diagnostics Radiation Laboratory Network (Rad-LN) AUTOMATION & HIGH THROUGHPUT Rad-LN –PARTNERS –- ASPR –- CDC –- NIH (NIAID, NCI) –- BARDA –- AHRQ –- DOD (DTRA, AFFRI) –- VA –- DHS (FEMA, DNDO, S and T) –- DOE (REAC/TS –Experts (Gov’t, Private, International) –- State, Local, TT