The Medical Decision Model and Decision Maker Tools for Management of Radiological and Nuclear Incidents

Koerner, John F.; Coleman, C. Norman; Murrain-Hill, Paula; FitzGerald, Denis J.; Sullivan, John E.

doi:10.1097/hp.0000000000000053

Cited by 12 publications

(8 citation statements)

References 1 publication

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“…The risk of a major radiological incident, resulting from an accident in a nuclear power plant, such as in Fukushima, or from a terrorist device emitting radiation, has drawn increasing attention over the last years. Among the different consequences of such incident, the determination of the amount of the exposure and the appropriate management of overexposed individuals will be a major parameter [ 1 , 2 ]. Those scenarios are studied and handled by many different actors, both on a national and international level, as official institutions have developed several programs aiming at developing tools to face those situations.…”

Section: Introductionmentioning

confidence: 99%

Tooth Retrospective Dosimetry Using Electron Paramagnetic Resonance: Influence of Irradiated Dental Composites

et al. 2015

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In the aftermath of a major radiological accident, the medical management of overexposed individuals will rely on the determination of the dose of ionizing radiations absorbed by the victims. Because people in the general population do not possess conventional dosimeters, after the fact dose reconstruction methods are needed. Free radicals are induced by radiations in the tooth enamel of victims, in direct proportion to dose, and can be quantified using Electron Paramagnetic Resonance (EPR) spectrometry, a technique that was demonstrated to be very appropriate for mass triage. The presence of dimethacrylate based restorations on teeth can interfere with the dosimetric signal from the enamel, as free radicals could also be induced in the various composites used. The aim of the present study was to screen irradiated composites for a possible radiation-induced EPR signal, to characterize it, and evaluate a possible interference with the dosimetric signal of the enamel. We investigated the most common commercial composites, and experimental compositions, for a possible class effect. The effect of the dose was studied between 10 Gy and 100 Gy using high sensitivity X-band spectrometer. The influence of this radiation-induced signal from the composite on the dosimetric signal of the enamel was also investigated using a clinical L-Band EPR spectrometer, specifically developed in the EPR center at Dartmouth College. In X-band, a radiation-induced signal was observed for high doses (25-100 Gy); it was rapidly decaying, and not detected after only 24h post irradiation. At 10 Gy, the signal was in most cases not measurable in the commercial composites tested, with the exception of 3 composites showing a significant intensity. In L-band study, only one irradiated commercial composite influenced significantly the dosimetric signal of the tooth, with an overestimation about 30%. In conclusion, the presence of the radiation-induced signal from dental composites should not significantly influence the dosimetry for early dose assessment.

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Section: Introductionmentioning

confidence: 99%

Tooth Retrospective Dosimetry Using Electron Paramagnetic Resonance: Influence of Irradiated Dental Composites

et al. 2015

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“…This experience led to the development of the "medical decision model" for how to work on a nuclear/radiological incident. 90,91 This model emphasized the importance of being able to make major decisions with partial information and to adapt, without being "wrong" or "defensive," as new information emerged. This is a skill common to emergency physicians and oncologists who frequently must make choices as the diagnosis unfolds with the information that they have available at the time.…”

Section: Core Elementmentioning

confidence: 99%

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

Coleman¹,

Bader²,

Koerner³

et al. 2019

Disaster med. public health prep.

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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.

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“…The decision-makers' guide contains critical information on aspects of a radiation or nuclear incident that can be used until SME support is available (Coleman et al 2012a, Koerner et al 2014). A web-based electronic version is in preparation.…”

Section: Response Tools and Resourcesmentioning

confidence: 99%

“…Resources have been developed to aid responders in providing information and life-saving instructions to the public (FEMA 2013b, CDC 2014b, Koerner et al 2014). The resources have been reviewed and tested by state and local responders and communications experts.…”

Section: Response Tools and Resourcesmentioning

confidence: 99%

Public Health and Medical Preparedness for a Nuclear Detonation

Coleman¹,

Sullivan²,

Bader³

et al. 2015

Health Physics

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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.

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The Medical Decision Model and Decision Maker Tools for Management of Radiological and Nuclear Incidents

Cited by 12 publications

References 1 publication

Tooth Retrospective Dosimetry Using Electron Paramagnetic Resonance: Influence of Irradiated Dental Composites

Tooth Retrospective Dosimetry Using Electron Paramagnetic Resonance: Influence of Irradiated Dental Composites

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

Public Health and Medical Preparedness for a Nuclear Detonation

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