Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-26T13:02:46.173Z Has data issue: false hasContentIssue false

Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) Science and the CBRNE Science Medical Operations Science Support Expert (CMOSSE)

Published online by Cambridge University Press:  17 June 2019

James J. James
Affiliation:
Society for Disaster Medicine and Public Health, Rockville, Maryland
Monique K. Mansoura
Affiliation:
MITRE Corporation, Bedford, Massachusetts
Alicia A. Livinski
Affiliation:
National Institutes of Health Library, Office of Research Services, Office of the Director, National Institutes of Health, Bethesda, Maryland
Andrea DiCarlo-Cohen
Affiliation:
Radiation and Nuclear Countermeasures Program, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
Brooke Buddemeier
Affiliation:
Lawrence Livermore National Laboratory, Livermore, California
Rocco Casagrande
Affiliation:
Gryphon Scientific, Tacoma Park, MD
Cullen Case Jr
Affiliation:
National Marrow Donor Program / Radiation Injury Treatment Network, Minneapolis, Minnesota
David M. Weinstock
Affiliation:
Dana Farber Cancer Institute and Harvard Medical School, Boston, MA
Nicholas Dainiak
Affiliation:
Yale University School of Medicine, New Haven, CT
Irwin Redlener
Affiliation:
National Center for Disaster Preparedness, Earth Institute at Columbia University, New York, New York
Tammy P. Taylor
Affiliation:
National Security Directorate, Pacific Northwest National Laboratory, Richland, Washington
Aubrey Miller
Affiliation:
National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland
Richard Hatchett
Affiliation:
Coalition for Epidemic Preparedness Innovations, London, England, UK

Abstract

A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.

Type
Concepts in Disaster Medicine
Copyright
Copyright © 2019 Society for Disaster Medicine and Public Health, Inc. This is a work of the U.S. Government and is not subject to copyright protection in the United States. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Federal Emergency Management Agency, Department of Homeland Security. National Planning Scenarios. https://www.fema.gov/txt/media/factsheets/2009/npd_natl_plan_scenario.txt. Accessed April 26, 2019.Google Scholar
Alai, M, Askin, A, Buddemeier, B, et al. Radiological Operations Support Specialist (ROSS) Pilot Course Summary and Recommendations. Livermore, CA: Lawrence Livermore National Laboratory; September 30, 2016.CrossRefGoogle Scholar
Advisory Team for Environment, Food and Health. https://cdn.ymaws.com/www.crcpd.org/resource/resmgr/ATeam/Ateam.htm. Accessed April 26, 2019.Google Scholar
Department of Homeland Security. Response Federal Interagency Operational Plan. 2nd ed. Washington, DC: Department of Homeland Security; August 2016. https://www.fema.gov/media-library-data/1471452095112-507e23ad4d85449ff131c2b025743101/Response_FIOP_2nd.pdf. Accessed April 26, 2019.Google Scholar
Department of Homeland Security. National Response Framework. 3rd ed. Washington, DC: Department of Homeland Security; June 2016. https://www.fema.gov/media-library-data/1466014682982-9bcf8245ba4c60c120aa915abe74e15d/National_Response_Framework3rd.pdf. Accessed April 26, 2019.Google Scholar
Department of Homeland Security. Nuclear/Radiological Incident Annex to the Response and Recovery Federal Interagency Operational Plans. Washington, DC: Department of Homeland Security; October 2016. https://www.fema.gov/media-library-data/1478636264406-cd6307630737c2e3b8f4e0352476c1e0/NRIA_FINAL_110216.pdf. Accessed April 26, 2019.Google Scholar
Federal Emergency Management Agency, Department of Homeland Security. National Preparedness Cycle. http://www.coehsem.com/emergency-management-cycle/. Accessed April 26, 2019.Google Scholar
Assistant Secretary for Preparedness and Response, Department of Health and Human Services. Public Health Emergency Medical Countermeasures Enterprise. https://www.phe.gov/Preparedness/mcm/phemce/Pages/default.aspx. Accessed April 26, 2019.Google Scholar
Department of Health and Human Services Part A: Office of the Secretary, Chapter AN: Office of Public Health Emergency Preparedness. https://www.hhs.gov/sites/default/files/hhsmanuals/hhsorganizational/an.pdf. Accessed April 26, 2019.Google Scholar
Project BioShield Act of 2004. Public Law No. 108-276, July 21, 2004.Google Scholar
Assistant Secretary for Preparedness and Response, Department of Health and Human Services. 2017-2018 PHEMCE Strategy and Implementation Plan. Washington, DC: Assistant Secretary for Preparedness and Response; December 2017: https://www.phe.gov/Preparedness/mcm/phemce/Pages/strategy.aspx. Accessed April 26, 2019.Google Scholar
Coleman, CN, Hrdina, C, Casagrande, R, et al. User-managed inventory: an approach to forward-deployment of urgently needed medical countermeasures for mass-casualty and terrorism incidents. DisasterMed Public Health Prep. Dec 2012;6(4):408414.CrossRefGoogle ScholarPubMed
Casagrande, R, Wills, N, Kramer, E, et al. Using the model of resource and time-based triage (MORTT) to guide scarce resource allocation in the aftermath of a nuclear detonation. DisasterMed Public Health Prep. Mar 2011;5(Suppl1):S98110.CrossRefGoogle ScholarPubMed
Hick, JL, Bader, JL, Coleman, CN, et al. Proposed “exposure and symptom triage” (EAST) tool to assess radiation exposure after a nuclear detonation. DisasterMed Public Health Prep. 2018;12(3):386395.CrossRefGoogle ScholarPubMed
Caro, JJ, DeRenzo, EG, Coleman, CN, et al. Resource allocation after a nuclear detonation incident: Unaltered standards of ethical decision making. DisasterMed Public Health Prep. Mar 2011;5(Suppl1):S46S53.CrossRefGoogle ScholarPubMed
Department of Health and Human Services. GeoHEALTH Platform. https://geohealth.hhs.gov/arcgis/home/. Accessed April 26, 2019.Google Scholar
Federal Emergency Management Agency, Department of Homeland Security. Emergency Support Function #8—Public Health and Medical Services Annex. https://www.fema.gov/media-library-data/20130726-1825-25045-8027/emergency_support_function_8_public_health___medical_services_annex_2008.pdf. Published January 2008. Accessed December 19, 2017.Google Scholar
Homeland Security Council, Interagency Policy Coordination Subcommittee for Preparedness and Response to Radiological and Nuclear Threats. Planning Guidance for Response to a Nuclear Detonation. 2nd ed. http://www.remm.nlm.gov/PlanningGuidanceNuclearDetonation.pdf. Published 2010. Accessed April 26, 2019.Google Scholar
Domestic Readiness Group, National Security Council. Health and Safety Planning Guide - For Planners, Safety Officers, and Supervisors for Protecting Responders Following a Nuclear Detonation. https://www.remm.nlm.gov/ind_health_safety.htm. Published December 2016. Accessed April 26, 2019.Google Scholar
Interagency Nuclear Detonation Response Communications Working Group. Improvised Nuclear Device Response and Recovery: Communicating in the Immediate Aftermath. https://www.fema.gov/media-library/assets/documents/33036?id=7659. Published June 2013. Accessed April 26, 2019.Google Scholar
Department of Homeland Security. Emergency Support Function 15: Standard Operating Procedures. July 2016. https://www.fema.gov/media-library-data/1469621171375-60d307a6345fad752633d2e2e21d1db2/ESF15_SOP_07.06.2016.3.pdf. Accessed April 26, 2019.Google Scholar
International Atomic Energy Agency. Joint radiation emergency management plan of the international organizations. Emergency Preparedness and Response. Vienna: International Atomic Energy Agency; 2017. http://www-pub.iaea.org/books/IAEABooks/11163/Joint-Radiation-Emergency-Management-Plan-of-the-International-Organizations. Accessed April 26, 2019.Google Scholar
Murrain-Hill, P, Coleman, CN, Hick, JL, et al. Medical response to a nuclear detonation: creating a playbook for state and local planners and responders. DisasterMed Public Health Prep. 2011;5(S1):S89S97.CrossRefGoogle ScholarPubMed
Assistant Secretary for Preparedness and Response, Department of Health and Human Services. A Decision Makers Guide: Medical Planning and Response for a Nuclear Detonation. 2nd ed. Washington, DC: Assistant Secretary for Preparedness and Response; November 2017. https://www.remm.nlm.gov/IND_Decision_Makers_Guide_2017_guides.pdf. Accessed April 26, 2019.Google Scholar
National Council on Radiation Protection and Measurements. https://ncrponline.org/. Accessed April 26, 2019.Google Scholar
Assistant Secretary for Preparedness and Response, Department of Health and Human Services. Strategic National Stockpile. https://www.phe.gov/about/sns/Pages/default.aspx. Accessed April 26, 2019.Google Scholar
Sproull, M, Camphausen, K. State-of-the-art advances in radiation biodosimetry for mass casualty events involving radiation exposure. Radiat Res. 2016;186(5):423435.CrossRefGoogle ScholarPubMed
Sullivan, JM, Prasanna, PG, Grace, MB, et al. Assessment of biodosimetry methods for a mass-casualty radiological incident: medical response and management considerations. Health Phys. 2013;105(6):540554.CrossRefGoogle ScholarPubMed
Federal Emergency Management Agency, Department of Homeland Security. Radiological Emergency Preparedness Program. https://www.fema.gov/radiological-emergency-preparedness-program. Accessed April 26, 2019.Google Scholar
National Association of County & City Health Officials. Radiation Preparedness. https://www.naccho.org/uploads/downloadable-resources/16-03-Local-Radiation-Preparedness.pdf. Accessed May 22, 2019.Google Scholar
Blumenthal, DJ, Bader, JL, Christensen, D, et al. A sustainable training strategy for improving health care following a catastrophic radiological or nuclear incident. Prehosp Disaster Med. 2014;29(1):8086.CrossRefGoogle ScholarPubMed
Bader, JL. The unmet need to engage/train/prepare the medical community for mass casualty radiation incidents. Assessment of National Efforts in Emergency Preparedness for Nuclear Terrorism: Is There a Need for Realignment to Close Remaining Gaps? National Council on Radiation Protection and Measurements 53rd Annual Meeting; March 6–7, 2017; Bethesda, MD.Google Scholar
Coleman, CN. All-of-nation planning approach to medical preparedness and effective response. Assessment of National Efforts in Emergency Preparedness for Nuclear Terrorism: Is There a Need for Realignment to Close Remaining Gaps? National Council on Radiation Protection and Measurements 53rd Annual Meeting; March 6–7, 2017; Bethesda, MD.Google Scholar
Hanfling, D. When the walls come tumbling down: medical surge response to IND. Assessment of National Efforts in Emergency Preparedness for Nuclear Terrorism: Is There a Need for Realignment to Close Remaining Gaps? National Council on Radiation Protection and Measurements 53rd Annual Meeting; March 6–7, 2017; Bethesda, MD.Google Scholar
Hick, J. Triaging thousands - challenges in survivor screening after a nuclear detonation. Assessment of National Efforts in Emergency Preparedness for Nuclear Terrorism: Is There a Need for Realignment to Close Remaining Gaps? National Council on Radiation Protection and Measurements 53rd Annual Meeting; March 6–7, 2017; Bethesda, MD.Google Scholar
Case, C. First receiver gaps. Assessment of National Efforts in Emergency Preparedness for Nuclear Terrorism: Is There a Need for Realignment to Close Remaining Gaps? National Council on Radiation Protection and Measurements 53rd Annual Meeting; March 6–7, 2017; Bethesda, MD.Google Scholar
Oak Ridge Institute for Science and Education, Department of Energy. Radiation Emergency Assistance Center/Training Site. https://orise.orau.gov/reacts/. Accessed April 26, 2019.Google Scholar
Department of Energy. Counterterrorism Operations Support, Center for Radiological Nuclear Training at the Nevada National Security Site. http://www.ctosnnsa.org/. Accessed April 26, 2019.Google Scholar
Uniformed Services University. Armed Forces Radiobiology Research Institute. https://www.usuhs.edu/afrri. Accessed April 26, 2019.Google Scholar
Centers for Disease Control and Prevention. Radiation Emergency Training, Education, and Tools. https://emergency.cdc.gov/radiation/training.asp. Accessed April 26, 2019.Google Scholar
Radiation Injury Treatment Network. https://ritn.net/. Accessed April 26, 2019.Google Scholar
Hrdina, CM, Coleman, CN, Bogucki, S, et al. The “RTR” medical response system for nuclear and radiological mass-casualty incidents: a functional TRiage-TReatment-TRansport medical response model. Prehosp Disaster Med. 2009;24(3):167178.CrossRefGoogle ScholarPubMed
Assistant Secretary for Preparedness and Response, Department of Health and Human Services. Hospital Preparedness Program. https://www.phe.gov/Preparedness/planning/hpp/Pages/default.aspx. Accessed April 26, 2019.Google Scholar
Centers for Disease Control and Prevention. Public Health Emergency Preparedness Cooperative Agreement. https://www.cdc.gov/phpr/readiness/phep.htm. Accessed April 26, 2019.Google Scholar
Centers for Disease Control and Prevention. Cities Readiness Initiative. https://www.cdc.gov/cpr/readiness/mcm/cri.html. Accessed May 22, 2019.Google Scholar
Coleman, CN, Knebel, AR, Hick, JL, et al. Scarce resources for nuclear detonation: Project overview and challenges. DisasterMed Public Health Prep. 2011;5(Suppl 1):S13S19.CrossRefGoogle ScholarPubMed
Knebel, AR, Coleman, CN, Cliffer, KD, et al. Allocation of scarce resources after a nuclear detonation: setting the context. DisasterMed Public Health Prep. 2011;5(s1):S20S31.CrossRefGoogle ScholarPubMed
Radiation Emergency Medical Management. Public Information Officers: Communicating After an IND detonation: Resource for Responders and Officials. https://www.remm.nlm.gov/remm_pio.htm#ind. Accessed April 26, 2019.Google Scholar
Coleman, CN, Adams, S, Adrianopoli, C, et al. Medical planning and response for a nuclear detonation: a practical guide. Biosecur Bioterror. 2012;10(4):346371.CrossRefGoogle ScholarPubMed
National Council on Radiation Protection and Measurements. NCRP Report No. 165: Responding to a Radiological or Nuclear Terrorism Incident: A Guide for Decision Makers. Appendix B, Public Information Statements. http://www.radiationready.org/wp/wp-content/uploads/2012/02/NCRP-REPORT-No-165-Public-Information-Statements.pdf. Accessed May 1, 2019.Google Scholar
Johns Hopkins Bloomberg School of Public Health, Center for Health Security, Rad Resilient City. http://www.centerforhealthsecurity.org/resources/interactives/rad-resilient-city/index. Accessed April 26, 2019.Google Scholar
National Council on Radiation Protection and Measurements. Advising the Public About Radiation Emergencies (National Council on Radiation Protection and Measurement Commentary No. 10). Available at https://ncrponline.org/shop/commentaries/commentary-no-10-advising-the-public-about-radiation-emergencies-1994/. Accessed April 26, 2019.Google Scholar
Sacks, B, Meyerson, G, Siegel, JA. Epidemiology without biology: false paradigms, unfounded assumptions, and specious statistics in radiation science (with commentaries by Inge Schmitz-Feuerhake and Christopher Busby and a reply by the authors). Biol Theory. 2016;11:69101.CrossRefGoogle Scholar
Assistant Secretary for Preparedness and Response, Department of Health and Human Services. Global Health Security Initiative. https://www.phe.gov/Preparedness/international/ghsi/pages/default.aspx. Accessed April 26, 2019.Google Scholar
International Atomic Energy Agency. Emergency Preparedness and Response. https://www.iaea.org/topics/emergency-preparedness-and-response-epr. April 26, 2019.Google Scholar
World Health Organization. Ionizing Radiation. https://www.who.int/ionizing_radiation/a_e/en/. Accessed April 26, 2019.Google Scholar
Federal Emergency Management Agency, Department of Homeland Security. Lesson 6: Incorporating ICS. https://emilms.fema.gov/IS362a/SMHP0106summary.htm. Accessed April 26, 2019.Google Scholar
Federal Emergency Management Agency, Department of Homeland Security. Appendix B: Incident Command System. Published December 2008. https://www.fema.gov/pdf/emergency/nims/NIMS_AppendixB.pdf. Accessed April 26, 2019.Google Scholar
Federal Emergency Management Agency, Department of Homeland Security. National Incident Management System. Published December 2008. https://www.fema.gov/pdf/emergency/nims/NIMS_core.pdf. Accessed April 26, 2019.Google Scholar
ReadyOp. Hospital Incident Command System. https://www.readyop.com/hospital-incident-command-system/. Accessed April 26, 2019.Google Scholar
Irwin, W. The ROSS: A rad/nuc subject matter expert filling a critical national need. Assessment of National Efforts in Emergency Preparedness for Nuclear Terrorism: Is There a Need for Realignment to Close Remaining Gaps? National Council on Radiation Protection and Measurements 53rd Annual Meeting; March 6–7, 2017; Bethesda, MD.Google Scholar
National Nuclear Security Administration, Nuclear Incident Response, with link to Federal Radiological Monitoring and Assessment Center (FRMAC). https://www.energy.gov/nnsa/nuclear-incident-response. Accessed May 23, 2019.Google Scholar
Federal Emergency Management Agency, Department of Homeland Security. Interagency Modeling and Atmospheric Assessment Center. https://www.dhs.gov/imaac. Accessed April 26, 2019.Google Scholar
Department of Health and Human Services, National Institutes of Health, National Library of Medicine. Radiation Emergency Medical Management: REMM. http://remm.nlm.gov. Published 2014. Accessed April 26, 2019.Google Scholar
Department of Health and Human Services, National Institutes of Health, National Library of Medicine. Chemical Hazards Emergency Medical Management: CHEMM. https://chemm.nlm.nih.gov/. Accessed April 26, 2019.Google Scholar
Assistant Secretary for Preparedness and Response, Department of Health and Human Services. Technical Resources, Assistance Center, and Information Exchange. https://asprtracie.hhs.gov/. Accessed April 26, 2019.Google Scholar
Centers for Disease Control and Prevention. Radiation Emergencies. https://www.cdc.gov/cpr/readiness/mcm/cri.html. Accessed May 22, 2019.Google Scholar
National Council on Radiation Protection and Measurements. Responding to a Radiological or Nuclear Terrorism Incident: A Guide for Decision Makers. National Council on Radiation Protection and Measurements Report No. 165. http://ncrponline.org/wp-content/themes/ncrp/PDFs/2017/NCRP_Report_No.165_complimentary.pdf. Published 2010. Accessed April 26, 2019.Google Scholar
Hanfling, D, Burkle, FM, Dallas, C. The right planning now will save countless lives after a nuclear attack. Bull At Sci. 2017;73(4):220225.CrossRefGoogle Scholar
Carter, A, May, M, Perry, W. The day after: action following a nuclear blast in a U.S. city. Wash Q. 2007;30(4):1932.CrossRefGoogle Scholar
Dallas, CE, Klein, KR, Lehman, T, et al. Readiness for radiological and nuclear events among emergency medical personnel. Front Public Health. 2017;5:202.CrossRefGoogle ScholarPubMed
Hauer, JM. US cities are not medically prepared for a nuclear detonation. Bull At Sci. 2017;73(4):215219.CrossRefGoogle Scholar
Radiation Emergency Medical Management. Recovery / Resilience after Radiation Emergencies. https://www.remm.nlm.gov/recovery.htm. Accessed May 22, 2019.Google Scholar
Fujitani, K, Carroll, M, Yanagisawa, R, et al. Burnout and psychiatric distress in local caregivers two years after the 2011 Great East Japan Earthquake and Fukushima nuclear radiation disaster. Community Ment Health J. 2016;52(1):3945.CrossRefGoogle Scholar
Murakami, M, Takebayashi, Y, Takeda, Y, et al. Effect of Radiological Countermeasures on Subjective Well-Being and Radiation Anxiety after the 2011 Disaster: The Fukushima Health Management Survey. Int J Environ Res Public Health. 2018;15(1). doi: 10.3390/ijerph15010124. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800223/. Accessed May 22, 2019.CrossRefGoogle ScholarPubMed
Lawrence Livermore National Laboratory. Response and Recovery Knowledge Product: Key Planning Factors For Recovery from a Radiological Terrorism Incident. Washington, DC: Department of Homeland Security; September 2012. https://www.fema.gov/media-library-data/20130726-1911-25045-2546/30_rrkp_key_planning_factors_radiological_incident.pdf. Accessed April 26, 2019.Google Scholar
National Council on Radiation Protection and Measurements. Decision Making for Late-Phase Recovery from Major Nuclear or Radiological Incidents. NCRP Report No. 175. Bethesda, MD: National Council on Radiation Protection and Measurements; 2014.Google Scholar
Chen, SY. Decision making for late-phase recovery from nuclear or radiological incidents. Health Phys. 2015;108(2):161169.CrossRefGoogle ScholarPubMed
Nisbet, AF, Chen, SY. Decision making for late-phase recovery from nuclear or radiological incidents: new guidance from NCRP. Ann ICRP. 2015;44(1 Suppl):162171.CrossRefGoogle ScholarPubMed
Public Health England. UK Recovery Handbooks for Radiation Incidents 2015 - Abstract, version 4 (PHE-CRCE-018). London: Public Health England; 2015. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/432743/PHE-CRCE-018_Abstract.pdf. Accessed April 26, 2019.Google Scholar
Public Health England. UK Recovery Handbooks for Radiation Incidents 2015 - Food Production Systems Handbook, version 4 (PHE-CRCE-018). London: Public Health England; 2015. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/432907/PHE-CRCE-018_Food_Production_Systems_Handbook_2015.pdf. Accessed April 26, 2019.Google Scholar
Public Health England. UK Recovery Handbooks for Radiation Incidents 2015 - Inhabited Areas Handbook, version 4 (PHE-CRCE-018). London: Public Health England; 2015. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/432742/PHE-CRCE-018_Inhabited_Areas_Handbook_2015.pdf. Accessed April 26, 2019.Google Scholar
Public Health England. UK Recovery Handbooks for Radiation Incidents 2015 - Drinking Water Supplies Handbook, version 4 (PHE-CRCE-018). London: Public Health England; 2015. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/433689/PHE-CRCE-018_Drinking_Water_Supplies_Handbook_2015.pdf. Accessed April 26, 2019.Google Scholar
International Commission on Radiological Protection. Application of the Commission’s recommendations to the protection of people living in long-term contaminated areas after a nuclear accident or a radiation emergency (ICRP publication 111). Ann ICRP. 2009; 39(3): 170. https://journals.sagepub.com/doi/pdf/10.1177/ANIB_39_3. Accessed May 23, 2019.Google Scholar
International Atomic Energy Agency. Disposal of Waste from the Cleanup of Large Areas Contaminated as a Result of a Nuclear Accident. Technical Reports Series No. 330. https://www-pub.iaea.org/MTCD/Publications/PDF/trs330_web.pdf. Accessed May 22, 2019.Google Scholar
Occupational Safety and Health Administration, Department of Labor. Resilience Resources for Emergency Response. https://www.osha.gov/SLTC/emergencypreparedness/resilience_resources/index.html. Accessed April 26, 2019.Google Scholar
Environmental Protection Agency. Summary of the Comprehensive Environmental Response, Compensation, and Liability Act (Superfund). https://www.epa.gov/laws-regulations/summary-comprehensive-environmental-response-compensation-and-liability-act. Accessed April 26, 2019.Google Scholar
Environmental Protection Agency. Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) and Federal Facilities. https://www.epa.gov/enforcement/comprehensive-environmental-response-compensation-and-liability-act-cercla-and-federal. Accessed April 26, 2019.Google Scholar
Environmental Protection Agency. PAG Manual: Protective Action Guides and Planning Guidance for Radiological Incidents. Washington, DC: Environmental Protection Agency. https://www.remm.nlm.gov/EPA_PAG_Manual_FINAL_01-26-2017.pdf. Accessed April 26, 2019.Google Scholar
Coleman, CN, Blumenthal, DJ, Casto, CA, et al. Recovery and resilience after a nuclear power plant disaster: a medical decision model for managing an effective, timely, and balanced response. Disaster Med Public Health Prep. 2013;7(2):136145.CrossRefGoogle ScholarPubMed
Koerner, JF, Coleman, CN, Murrain-Hill, P, et al. The medical decision model and decision maker tools for management of radiological and nuclear incidents. Health Phys. 2014;106(6):645651.CrossRefGoogle ScholarPubMed
Coleman, CN, Sullivan, JM, Bader, JL, et al. Public health and medical preparedness for a nuclear detonation: the nuclear incident medical enterprise. Health Phys. 2015;108(2):149160.CrossRefGoogle ScholarPubMed
Assistant Secretary for Preparedness and Response, Department of Health and Human Services. What is Science Preparedness? https://www.phe.gov/Preparedness/planning/science/Pages/overview.aspx. Accessed April 26, 2019.Google Scholar
Miller, A, Yeskey, K, Garantziotis, S, et al. Integrating health research into disaster response: the new NIH disaster research response program. Int J Environ Res Public Health. 2016 Jul;13(7). doi: 10.3390/ijerph13070676. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962217/. Accessed May 22, 2019.CrossRefGoogle ScholarPubMed
National Institutes of Health. Disaster Research Response (DR2). https://dr2.nlm.nih.gov/. Accessed April 26, 2019.Google Scholar
Johns Hopkins Bloomberg School of Public Health, Center for Health Security. http://www.centerforhealthsecurity.org/. Accessed April 26, 2019.Google Scholar
Supplementary material: PDF

Coleman et al. supplementary material

Appendix

Download Coleman et al. supplementary material(PDF)
PDF 1.2 MB