title: Public health and medical preparedness for a nuclear detonation: the nuclear incident medical enterprise.
abstract: Resilience and the ability to mitigate the consequences of a nuclear incident are enhanced by (1) effective planning, preparation and training; (2) ongoing interaction, formal exercises, and evaluation among the sectors involved; (3) effective and timely response and communication; and (4) continuous improvements based on new science, technology, experience, and ideas. Public health and medical planning require a complex, multi-faceted systematic approach involving federal, state, local, tribal, and territorial governments; private sector organizations; academia; industry; international partners; and individual experts and volunteers. The approach developed by the U.S. Department of Health and Human Services Nuclear Incident Medical Enterprise (NIME) is the result of efforts from government and nongovernment experts. It is a "bottom-up" systematic approach built on the available and emerging science that considers physical infrastructure damage, the spectrum of injuries, a scarce resources setting, the need for decision making in the face of a rapidly evolving situation with limited information early on, timely communication, and the need for tools and just-in-time information for responders who will likely be unfamiliar with radiation medicine and uncertain and overwhelmed in the face of the large number of casualties and the presence of radioactivity. The components of NIME can be used to support planning for, response to, and recovery from the effects of a nuclear incident. Recognizing that it is a continuous work-in-progress, the current status of the public health and medical preparedness and response for a nuclear incident is provided.
authors.affiliation: *Office of Emergency Management, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC; †Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD; ‡Dana Farber Cancer Institute, Harvard Medical School, Boston, MA; §Radiation Injury Treatment Network, National Marrow Donor Program, Minneapolis, MN; **Office of Policy and Planning, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC; ††Division of Strategic National Stockpile, Office of Public Health Preparedness and Response; Centers for Disease Control and Prevention, Atlanta, GA; ‡‡Radiation Studies Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA; §§Gryphon Scientific, LLC, Rockville, MD; ***Biomedical Advanced Research & Development Authority, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC; †††Radiation/Nuclear Countermeasures Program, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.
authors.forename: C Norman
authors.initials: CN
authors.lastname: Coleman
authors.forename: Julie M
authors.initials: JM
authors.lastname: Sullivan
authors.forename: Judith L
authors.initials: JL
authors.lastname: Bader
authors.forename: Paula
authors.initials: P
authors.lastname: Murrain-Hill
authors.forename: John F
authors.initials: JF
authors.lastname: Koerner
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Garrett
authors.forename: David M
authors.initials: DM
authors.lastname: Weinstock
authors.forename: Cullen
authors.initials: C
authors.lastname: Case
authors.forename: Chad
authors.initials: C
authors.lastname: Hrdina
authors.forename: Steven A
authors.initials: SA
authors.lastname: Adams
authors.forename: Robert C
authors.initials: RC
authors.lastname: Whitcomb
authors.forename: Ellie
authors.initials: E
authors.lastname: Graeden
authors.forename: Robert
authors.initials: R
authors.lastname: Shankman
authors.forename: Timothy
authors.initials: T
authors.lastname: Lant
authors.forename: Bert W
authors.initials: BW
authors.lastname: Maidment
authors.forename: Richard C
authors.initials: RC
authors.lastname: Hatchett
mesh_terms: D003142:Communication; D004189:Disaster Planning / Q000379:methods*; D035082:Federal Government; D006077:Government Agencies; D006801:Humans; D033183:Interdisciplinary Communication; D054527:Mass Casualty Incidents; D009689:Nuclear Warfare; D011827:Radiation; D011832:Radiation Injuries; D018788:Radioactive Hazard Release; D011853:Radiobiology; D011874:Radiometry; D012306:Risk; D014481:United States; D054543:United States Department of Homeland Security