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

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.

Evaluation of Repurposing Archetypal Preventive Radiological/Nuclear Detectors for the Consequence Management Mission.

In the first hours or days after an unplanned release of radioactive material to the environment, the radiation detection instruments most widely available to local first responders may be those currently fielded for interdiction missions. This study investigated how such preventative radiological/nuclear detection instruments could perform if repurposed for consequence management missions. A representative sample of three archetypes (body-worn, human-carried, and other/large-detection-volume equipment) encompassed six categories: personal radiation detector, extended-range personal radiation detector, personal emergency radiation detector, radioisotope identification device, human-portable detector/backpack, and vehicle-mounted large-detection-volume detector. Overall 19 models of equipment were included in the study. Laboratory evaluations were designed to assess the capabilities of the instruments in four consequence management missions: exposure rate, integrated exposure, radiation survey, and contamination screening. As applicable, the evaluations included measurement of exposure rate, integrated exposure, overrange response, and angular response. The results were compared to benchmarks from the American National Standards Institute N42.49A. The performance of the instruments for initial screening for contamination was assessed by an automated radioactive source moving past the detectors at various speeds and distances. The results demonstrate that if the equipment is used in accordance with the mission analysis and categories and within the original equipment manufacturer specifications, it is possible to achieve sufficient accuracy to estimate and document doses to responders, plan entries into contaminated areas, detect contamination, and protect the public until such time as outside resources arrive with sufficient numbers of standard health physics instruments and personnel dosimetry to replace the preventative radiological/nuclear detection instruments. This evaluation campaign was conducted to complement the National Council on Radiation Protection and Measurements Report 179, Guidance for Emergency Response Dosimetry.

How Prepared Are the Public and Responders for Nuclear Terrorism?

The theme of the 2017 Annual Meeting of the National Council on Radiation Protection and Measurements was "Assessment of National Efforts in Emergency Preparedness for Nuclear Terrorism: Is There a Need for Realignment to Close Remaining Gaps?" In the "Guidance, Training and Exercises: Emergency Responders" session, speakers explored our level of public and responder preparedness and the challenges to being adequately prepared. There were three themes expressed from the perspective of emergency responders. The federal government is effective at creating guidance and a systematic preparedness process but not so effective at engaging and implementing guidance and processes at the state and local level for technical hazards like radiation. Second, preparedness at the local level is driven by local leadership and champions who see the problem through a "different lens." These champions often have to overcome significant institutional, political, and social barriers associated with preparing for radiological events. Finally, there is a limit to the amount of general preparedness and public information that can be absorbed in the absence of a perceived threat. Occasionally, events lead to a heightened concern that offers a window of opportunity for a "learning moment."

NCRP Program Area Committee 3: Nuclear and Radiological Security and Safety.

The National Council on Radiation Protection and Measurements (NCRP) Program Area Committee (PAC) 3 covers the broad subject of nuclear and radiological security and safety and provides guidance and recommendations for response to nuclear and radiological incidents of both an accidental and deliberate nature. In 2017, PAC 3 Scientific Committee 3-1 completed the development of Guidance for Emergency Responder Dosimetry and began development of a companion commentary on operational aspects of that guidance. PAC 3 members also organized the technical program for the 2017 Annual Meeting of NCRP on "Assessment of National Efforts in Emergency Preparedness for Nuclear Terrorism: Is There a Need for Realignment to Close Remaining Gaps." Based on discussions and presentations at the annual meeting, PAC 3 is working to develop a commentary on the subject that could serve as a roadmap for focusing our national efforts on the most pressing needs for preparing the nation for nuclear and radiological emergencies. PAC 3 is also engaged in active discussions exploring the landscape of priority issues for its future activities. An important consideration in this discussion is the extent of NCRP's present and potential future resources to support the work of its scientific committees.

NCRP Program Area Committee 3: Nuclear and Radiological Security and Safety.

Program Area Committee (PAC) 3 provides guidance and recommendations for response to nuclear and radiological incidents of both an accidental and deliberate nature. Leadership of PAC 3 was transitioned in March 2015, and the newly composed PAC has been working to delineate and then prioritize the landscape of possible activities for PAC 3. The major activity of PAC 3 during the past year was the establishment of Scientific Committee 3-1 to begin producing a report on Guidance for Emergency Responder Dosimetry.

Updated Emergency Response Guidance for the First 48 h after the Outdoor Detonation of an Explosive Radiological Dispersal Device.

ABSTRACT: This paper updates portions of the guidance originally published in 2006 based on the interpretation of subsequent experiments simulating explosive aerosolization from a radiological dispersal device and three-dimensional modeling of a high-rise urban-canyon type environment and wind field. These new data increase confidence about the predicted range of radioactive ballistic fragments that could endanger first responders and the public. The results of the most recent complete set of experiments indicate that the previously recommended initial hazard boundary corresponding to the potential for acute health effects can be reduced from 500 m to 250 m. This revised recommendation is independent of the total activity of the radioactive material. The assessment of the potential range and effects of dispersal from small particles as aerosol remains unchanged from the guidance issued in 2006. New recommendations are offered on sheltering versus evacuation and how to conduct the initial field measurements so as to make early decisions on protecting the public and responders, and providing coherent data for an assessment scientist to make a first estimate of the source term in the device.

Medical planning and response for a nuclear detonation: a practical guide.

This article summarizes major points from a newly released guide published online by the Office of the Assistant Secretary for Preparedness and Response (ASPR). The article reviews basic principles about radiation and its measurement, short-term and long-term effects of radiation, and medical countermeasures as well as essential information about how to prepare for and respond to a nuclear detonation. A link is provided to the manual itself, which in turn is heavily referenced for readers who wish to have more detail.

Allocation of scarce resources after a nuclear detonation: setting the context.

The purpose of this article is to set the context for this special issue of Disaster Medicine and Public Health Preparedness on the allocation of scarce resources in an improvised nuclear device incident. A nuclear detonation occurs when a sufficient amount of fissile material is brought suddenly together to reach critical mass and cause an explosion. Although the chance of a nuclear detonation is thought to be small, the consequences are potentially catastrophic, so planning for an effective medical response is necessary, albeit complex. A substantial nuclear detonation will result in physical effects and a great number of casualties that will require an organized medical response to save lives. With this type of incident, the demand for resources to treat casualties will far exceed what is available. To meet the goal of providing medical care (including symptomatic/palliative care) with fairness as the underlying ethical principle, planning for allocation of scarce resources among all involved sectors needs to be integrated and practiced. With thoughtful and realistic planning, the medical response in the chaotic environment may be made more effective and efficient for both victims and medical responders.

Explosions and radioactive material: a primer for responders.

A comprehensive primer on the threat posed by radiological dispersion devices, or "dirty bombs," and the management challenges for first responders is presented. The discussion is scenario-driven, presenting guidance for medical responders as to triage and treatment priorities in the face of radiation risk. Key questions are posed that present the need for operational and tactical planning, equipping, and training around this scenario. Decontamination priorities and potential medical management are discussed for both victims and responders.

Overview of hazard assessment and emergency planning software of use to RN first responders.

There are numerous software tools available for field deployment, reach-back, training and planning use in the event of a radiological or nuclear terrorist event. Specialized software tools used by CBRNe responders can increase information available and the speed and accuracy of the response, thereby ensuring that radiation doses to responders, receivers, and the general public are kept as low as reasonably achievable. Software designed to provide health care providers with assistance in selecting appropriate countermeasures or therapeutic interventions in a timely fashion can improve the potential for positive patient outcome. This paper reviews various software applications of relevance to radiological and nuclear events that are currently in use by first responders, emergency planners, medical receivers, and criminal investigators.