title: A sustainable training strategy for improving health care following a catastrophic radiological or nuclear incident.
abstract: The detonation of a nuclear device in a US city would be catastrophic. Enormous loss of life and injuries would characterize an incident with profound human, political, social, and economic implications. Nevertheless, most responders have not received sufficient training about ionizing radiation, principles of radiation safety, or managing, diagnosing, and treating radiation-related injuries and illnesses. Members throughout the health care delivery system, including medical first responders, hospital first receivers, and health care institution support personnel such as janitors, hospital administrators, and security personnel, lack radiation-related training. This lack of knowledge can lead to failure of these groups to respond appropriately after a nuclear detonation or other major radiation incident and limit the effectiveness of the medical response and recovery effort. Efficacy of the response can be improved by getting each group the information it needs to do its job. This paper proposes a sustainable training strategy for spreading curricula throughout the necessary communities. It classifies the members of the health care delivery system into four tiers and identifies tasks for each tier and the radiation-relevant knowledge needed to perform these tasks. By providing education through additional modules to existing training structures, connecting radioactive contamination control to daily professional practices, and augmenting these systems with just-in-time training, the strategy creates a sustainable mechanism for giving members of the health care community improved ability to respond during a radiological or nuclear crisis, reducing fatalities, mitigating injuries, and improving the resiliency of the community.
authors: 1 US Department of Energy, National Nuclear Security Administration, Washington DC USA.
authors: Daniel J
authors: DJ
authors: Blumenthal
authors: 2 US Department of Health and Human Services, Washington DC USA.
authors: Judith L
authors: JL
authors: Bader
authors: 3 Radiation Emergency Assistance Center/Training Site, Oak Ridge, Tennessee USA.
authors: Doran
authors: D
authors: Christensen
authors: 4 US Department of Health and Human Services, Washington DC USA.
authors: John
authors: J
authors: Koerner
authors: 5 Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.
authors: John
authors: J
authors: Cuellar
authors: 6 Armed Forces Radiobiology Research Institute, Bethesda, Maryland USA.
authors: Sidney
authors: S
authors: Hinds
authors: 7 Oak Ridge Associated Universities, Oak Ridge Institute for Science and Education, Arlington, Virginia USA.
authors: John
authors: J
authors: Crapo
authors: 7 Oak Ridge Associated Universities, Oak Ridge Institute for Science and Education, Arlington, Virginia USA.
authors: Erik
authors: E
authors: Glassman
authors: 7 Oak Ridge Associated Universities, Oak Ridge Institute for Science and Education, Arlington, Virginia USA.
authors: A Bradley
authors: AB
authors: Potter
authors: 7 Oak Ridge Associated Universities, Oak Ridge Institute for Science and Education, Arlington, Virginia USA.
authors: Lynda
authors: L
authors: Singletary
mesh_terms: D003479:Curriculum; D003666:Decontamination / Q000592:standards; D003695:Delivery of Health Care / Q000458:organization & administration*; D004189:Disaster Planning; D004632:Emergency Medical Services / Q000458:organization & administration*; D004634:Emergency Medical Technicians / Q000193:education*; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D054527:Mass Casualty Incidents; D017146:Models, Organizational; D009689:Nuclear Warfare; D054043:Nuclear Weapons; D011832:Radiation Injuries / Q000175:diagnosis* / Q000628:therapy*; D018788:Radioactive Hazard Release; D023481:Terrorism; D014218:Triage / Q000458:organization & administration*