Background: Various organizations and universities have developed competencies for health professionals and other emergency responders. Little effort has been devoted to the integration of these competencies across health specialties and professions. The American Medical Association Center for Public Health Preparedness and Disaster Response convened an expert working group (EWG) to review extant competencies and achieve consensus on an educational framework and competency set from which educators could devise learning objectives and curricula tailored to fit the needs of all health professionals in a disaster. Methods: The EWG conducted a systematic review of peer-reviewed and non-peer reviewed published literature. In addition, after-action reports from Hurricane Katrina and relevant publications recommended by EWG members and other subject matter experts were reviewed for congruencies and gaps. Consensus was ensured through a 3-stage Delphi process. Results: The EWG process developed a new educational framework for disaster medicine and public health preparedness based on consensus identification of 7 core learning domains, 19 core competencies, and 73 specific competencies targeted at 3 broad health personnel categories. Conclusions: The competencies can be applied to a wide range of health professionals who are expected to perform at different levels (informed worker/student, practitioner, leader) according to experience, professional role, level of education, or job function. Although these competencies strongly reflect lessons learned following the health system response to Hurricane Katrina, it must be understood that preparedness is a process, and that these competencies must be reviewed continually and refined over time. (Disaster Med Public Health Preparedness. 2008;2:57-68)

Abstract-Free-ranging mammals near the Chornobyl nuclear reactor are experiencing substantial radiation dose rates from intramuscular concentrations of 134,137 Cs and skeletal 90 Sr. Radiocesium concentrations averaged 3,200 Bq/g of dry muscle, compared to a mean of 297 Bq 90 Sr/g in bone for mammals in the Exclusion Zone, a region of restricted human activity surrounding the reactor. Estimates of dose rates from intramuscular sources of radiocesium averaged 2.4 mGy/d within 8 km of the reactor and ranged as high as 60 mGy/d. Overall dose rates from internal 90 Sr for mammals in the Exclusion Zone averaged 1.0 mGy/d, although doses to specific tissues are likely much higher. Mammals captured 30 km southeast of the reactor averaged only 2 Bq/g of muscle and were receiving an average of 1.4 Gy/d from internal radiocesium. Dramatic variation exists in the spatial pattern of radiocesium in areas immediately surrounding the reactor and within and between remediated and unremediated regions. The variance of 90 Sr for taxa among sites was significantly less than that for 134,137 Cs. Thermoluminescent dosimeters placed on free-ranging mice showed that dose rates from external sources of radiation were much greater than the dose rates from internal sources of radiocesium. Estimated dose rates in very small areas of the Chornobyl region exceed those reported to impede reproductive success in mammals.

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Pharmacists' adoption of nonpharmaceutical supply roles may represent a problem of accepting a paradigm shift in nontraditional roles. Possible shortages of personnel in future disasters may change the pharmacists' approach to disaster management.

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Background: The threat posed by the use of weapons of mass destruction (WMD) within the United States has grown significantly in recent years, focusing attention on the medical and public health disaster capabilities of the nation in a large scale crisis. While the hundreds of thousands or millions of casualties resulting from a nuclear weapon would, in and of itself, overwhelm our current medical response capabilities, the response dilemma is further exacerbated in that these resources themselves would be significantly at risk. There are many limitations on the resources needed for mass casualty management, such as access to sufficient hospital beds including specialized beds for burn victims, respiration and supportive therapy, pharmaceutical intervention, and mass decontamination.

Background: Among medical providers, even though radiological and nuclear events are recognized as credible threats, there is a lack of knowledge and fear about the medical consequences among medical personnel which could significantly affect the treatment of patients injured and/or contaminated in such scenarios. This study was conducted to evaluate the relative knowledge, willingness to respond, and familiarity with nuclear/radiological contamination risks among U.S. and Japanese emergency medical personnel.Methods: An institutional review board-approved anonymous paper survey was distributed at various medical and disaster conferences and medicine courses in Japan and in the U.S. The surveys were written in Japanese and English and collected information on the following four categories: generalized demographics, willingness to manage, knowledge of disaster systems, and contamination risks.results: A total of 418 surveys were completed and collected. Demographics showed that physicians and prehospital responders were the prevalent survey responders. The majority of responders, despite self-professed disaster training, were still very uncomfortable with and unaware how to respond to a radiological/nuclear event.conclusion: Despite some educational coverage in courses and a limited number of disaster events, it is concluded that there is a lack of comfort and knowledge regarding nuclear and radiological events among the medical community. It is recommended that considerable development and subsequent distribution is needed to better educate and prepare the medical community for inevitable upcoming radiological/nuclear events.