The knowledge base on workforce absenteeism during disasters is growing, although in general this issue is underrepresented in emergency planning efforts. Our data suggest that a mitigation strategy that includes options for preferential access to either antiviral therapy, protective equipment, or both for the employee as well as his or her immediate family will have the greatest impact. These findings likely have import for other disasters involving contamination or contagion, and in critical infrastructure sectors beyond health care.

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.

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.

T he term megadisaster has worked its way into the mainstream since the start of the new millennium. The expression once reserved for the technical meaning of the word-a ''one in a million'' disaster-has recently been brought to the forefront by several large natural events that have occurred in the past 5 years, namely Hurricane Katrina in the United States and the Indian Ocean tsunami of 2004. These two disasters, as well as the terrorist attacks of September 2001 in the United States have directed a persistent spotlight on the systems by which the public and its government plan for, respond to, and recover from high-impact catastrophes.From the beginnings of human society, both nature and our own species have found ways to traumatically disrupt the status quo. Despite the many catastrophes in our history, the term disaster has been difficult to define. Most definitions include some reference to the event's impact on people, the economy, or the environment. More theoretically, a disaster can be seen as a complex function of risk and vulnerability. As an example, the magnitude of a hurricane disaster is not as simple as the force of the hurricane itself upon a community but rather a sum of those forces (eg, storm-force winds) plus the special vulnerabilities faced by the community (eg, levee failure) plus the community's capacity to reduce the actual or potential negative consequences of risk (eg, an inability to evacuate citizens). It is complicated interplay among the forces of destruction and the broad ability (or inability) of a community, for myriad reasons, to withstand them and mitigate their impact.There is ranging opinion and there has been much discussion about the practical definition of disaster, much of it dependent upon the context in which the term is being analyzed. Many academics feel that for an incident to be technically classified as a disaster, it must overwhelm the day-to-day routine enough

The modified Delphi process, used to derive novel PDT simulation and evaluation tools, yielded a high degree of consensus among the SMEs, and eliminated biases toward specific PDT strategies in the evaluations. The simulations and evaluation tools may now be tested for reliability and validity as part of a prehospital PDT curriculum.