[PPT] - THE RADIATION ONCOLOGISTS ROLE IN PREPAREDNESS PLANNING Andrew L. PowerPoint Presentation

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THE RADIATION ONCOLOGIST’S ROLE IN PREPAREDNESS PLANNING

Andrew L. Salner, MD FACR Director, Helen & Harry Gray Cancer Center Hartford Hospital, Hartford, CT p , , Chair, ASTRO Nuclear/Radiologic Response Committee

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DISCLOSURES: NONE DISCLOSURES: NONE

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OBJECTIVES OBJECTIVES

After this session attendees will be able to: After this session, attendees will be able to:

1‐understand the importance of local hospital

radiologic preparedness radiologic preparedness

2‐understand the components of a hospital

di i l radiation plan

3‐understand the important and unique role
f the radiation oncologist

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WHY PREPARE? WHY PREPARE?-1 WHY PREPARE? WHY PREPARE? 1

INCREASING LIKELIHOOD OF AN

INCREASING LIKELIHOOD OF AN EVENT EVENT

PUBLIC EXPECTS MEDICAL SYSTEM

PUBLIC EXPECTS MEDICAL SYSTEM WILL BE READY WILL BE READY-

BIOLOGIC AND

BIOLOGIC AND CHEMICAL PREPARATION IS READY CHEMICAL PREPARATION IS READY

RESPONSES ARE FIRST AND

RESPONSES ARE FIRST AND FOREMOST FOREMOST LOCAL LOCAL

SYSTEM(HOSPITALS,

SYSTEM(HOSPITALS, ROADS,ER’S) ROADS,ER’S) NOT READY NOT READY ROADS,ER S) ROADS,ER S) NOT READY NOT READY

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WHY PREPARE? WHY PREPARE?-2 WHY PREPARE? WHY PREPARE? 2

OTHER HEALTH CARE PROVIDERS NOT

OTHER HEALTH CARE PROVIDERS NOT COMFORTABLE WITH RADIATION ISSUES COMFORTABLE WITH RADIATION ISSUES

COORDINATED LOCAL RESPONSE CAN

COORDINATED LOCAL RESPONSE CAN OCCUR WITH PREPARATION OCCUR WITH PREPARATION

RADIATION ONCOLOGIST NATURAL

RADIATION ONCOLOGIST NATURAL CHAMPION FOR THIS EFFORT CHAMPION FOR THIS EFFORT

MANY HOSPITAL DISASTER PLANNING

MANY HOSPITAL DISASTER PLANNING EFFORTS LACKING IN THE EFFORTS LACKING IN THE RADIATION COMPONENT RADIATION COMPONENT

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today’s presentation today’s presentation today s presentation today s presentation

Event likelihood

Our hospitals and infrastructure

Our hospitals and infrastructure H it l l d t H it l l d t

Hospital plan and team

Connecticut pilot

Role of radiation oncologist

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LIKELIHOOD OF AN EVENT LIKELIHOOD OF AN EVENT LIKELIHOOD OF AN EVENT LIKELIHOOD OF AN EVENT

TERRORISM IS GROWING WORLDWIDE

HIGH PROBABILITY OF RETURNING TO OUR

HIGH PROBABILITY OF RETURNING TO OUR SHORES SHORES

RADIOACTIVE SOURCES READILY

RADIOACTIVE SOURCES READILY AVAILABLE AVAILABLE

SPREADING FEAR AND PANIC,

SPREADING FEAR AND PANIC, DISABLING OUR SYSTEMS, DISABLING OUR SYSTEMS, S G OU S S S, S G OU S S S, GETTING OUR ATTENTION, GETTING OUR ATTENTION, LOSS OF LIFE LOSS OF LIFE LOSS OF LIFE LOSS OF LIFE

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WE HAVE HAD AN EXPLOSION WE HAVE HAD AN EXPLOSION IN BOSTON THIS MIGHT BE A IN BOSTON THIS MIGHT BE A IN BOSTON. THIS MIGHT BE A IN BOSTON. THIS MIGHT BE A DIRTY BOMB. IF YOU DIRTY BOMB. IF YOU EXPERIENCE HEADACHE, EXPERIENCE HEADACHE, NAUSEA, OR FATIGUE, NAUSEA, OR FATIGUE, NAUSEA, OR FATIGUE, NAUSEA, OR FATIGUE, PROCEED AT ONCE TO THE PROCEED AT ONCE TO THE NEAREST MEDICAL FACILITY NEAREST MEDICAL FACILITY NEAREST MEDICAL FACILITY. NEAREST MEDICAL FACILITY. (simulated story simulated story) ( y)

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CHALLENGE OF AN EVENT CHALLENGE OF AN EVENT

ACCIDENT INCIDENT TERRORIST

CHALLENGE OF AN EVENT CHALLENGE OF AN EVENT

ACCIDENT, INCIDENT, TERRORIST

ACCIDENT, INCIDENT, TERRORIST ACT ACT

LARGE DEMAND ON HEALTHCARE

LARGE DEMAND ON HEALTHCARE FACILITIES FACILITIES VICTIMS POTENTIALLY EXPOSED VICTIMS POTENTIALLY EXPOSED

VICTIMS POTENTIALLY EXPOSED

VICTIMS POTENTIALLY EXPOSED AND/OR CONTAMINATED AND/OR CONTAMINATED

“WORRIED WELL”

MEDICAL AND PUBLIC HEALTH

MEDICAL AND PUBLIC HEALTH ISSUES ISSUES

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RADIATION INJURY RADIATION INJURY RADIATION INJURY RADIATION INJURY

EXPOSURE

Acute Radiation Syndrome

Acute Radiation Syndrome Acute Radiation Syndrome Acute Radiation Syndrome Hematopoietic/ GI/ CNS/ Cutaneous Hematopoietic/ GI/ CNS/ Cutaneous Subsyndromes Subsyndromes y

EXTERNAL CONTAMINATION

INTERNAL CONTAMINATION

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SYSTEM SYSTEM READINESS READINESS

ER’S OVERCROWDED

ER S OVERCROWDED

HOSPITALS FULL

LIMITED CAREGIVERS

ROADWAYS CONGESTED

POPULATION EASILY AND QUICKLY

POPULATION EASILY AND QUICKLY PANICKED PANICKED NOT SO READY!!

NOT SO READY!!

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Nation's Emergency Care System Is

Nation's Emergency Care System Is g y y g y y Fragmented, Unable To Respond To Disasters, Fragmented, Unable To Respond To Disasters, Says Institute Of Medicine Says Institute Of Medicine l i f i f f d l f di f l i f i f f d l f di f

nly a tiny fraction of federal funding for
nly a tiny fraction of federal funding for

emergency preparedness since 9/11 has been emergency preparedness since 9/11 has been spent on medical preparedness spent on medical preparedness spent on medical preparedness spent on medical preparedness

increasing responsibilities of hospital emergency

increasing responsibilities of hospital emergency departments, which are caring for patients departments, which are caring for patients without medical insurance and for insured without medical insurance and for insured patients unable to access their physicians patients unable to access their physicians

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ER STRESSORS ER STRESSORS IOM REPORT 6/06 IOM REPORT 6/06 IOM REPORT 6/06 IOM REPORT 6/06

ER VISITS GREW BY 23% 1996

ER VISITS GREW BY 23% 1996-

2003

2003

# ER’S DECLINED BY 425, BEDS BY 198,000

ER’S CROWDED BY LACK OF INPATIENT

ER’S CROWDED BY LACK OF INPATIENT BEDS(PTS BOARDED) BEDS(PTS BOARDED) BEDS(PTS BOARDED) BEDS(PTS BOARDED)

AMBULANCES FREQUENTLY DIVERTED

POOR EMS COORDINATION

SHORTAGE OF SPECIALISTS TO TAKE

SHORTAGE OF SPECIALISTS TO TAKE ER/TRAUMA CALL ER/TRAUMA CALL LITTLE OR NO SURGE CAPACITY LITTLE OR NO SURGE CAPACITY

LITTLE OR NO SURGE CAPACITY

SUPPLIES LACKING FOR PEDIATRIC

SUPPLIES LACKING FOR PEDIATRIC EMERGENCIES EMERGENCIES EMERGENCIES EMERGENCIES

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Transportation issues Transportation issues Transportation issues Transportation issues

US Dept of Transportation

INCREASING CONGESTION IN CITIES

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Highway Congestion Highway Congestion-

1

1 F d l Hi h Ad i i i F d l Hi h Ad i i i Federal Highway Administration Federal Highway Administration

INCREASING HOURS OF DELAY IN CITIES INCREASING HOURS OF DELAY IN CITIES

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Highway congestion Highway congestion-

2

2 F d l Hi h Ad i i i F d l Hi h Ad i i i Federal Highway Administration Federal Highway Administration

REASONS REASONS FOR MORE CONGESTION

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US National Guard US National Guard US National Guard US National Guard

EQUIPMENT SHORTAGE

Demands of wars since 9/11

Demands of wars since 9/11 strain strain National Guard's efforts National Guard's efforts National Guard s efforts National Guard s efforts

By Bryan Bender, Globe

By Bryan Bender, Globe St ff St ff | S t b 2 2005 S t b 2 2005 Staff Staff | September 2, 2005 September 2, 2005

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Health Care Providers Health Care Providers N W ll I f d N W ll I f d Not Well Informed Not Well Informed

Physicians, nurses do not know much about radiation

Physicians, nurses do not know much about radiation i i issues issues

ER physicians happy to manage patients but want

ER physicians happy to manage patients but want knowledgeable radiation colleagues with them knowledgeable radiation colleagues with them

General fear about staff and facility contamination and

General fear about staff and facility contamination and exposure exposure

Lack of understanding of difference between exposure

Lack of understanding of difference between exposure and contamination and contamination

Compelling rationale for

Compelling rationale for local hospital radiologic local hospital radiologic preparedness team preparedness team preparedness team preparedness team

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ER physician response ER physician response

“We are not

“We are not taking any taking any radiation radiation radiation radiation patients patients-

we don’t

we don’t have enough have enough have enough have enough shielding!” shielding!”

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DEVELOP HOSPITAL PLAN DEVELOP HOSPITAL PLAN DEVELOP HOSPITAL PLAN DEVELOP HOSPITAL PLAN

Radiologic preparedness component of

Radiologic preparedness component of hospital disaster plan hospital disaster plan

Needs radiation “champion” to develop

Needs radiation champion to develop

Needs radiation champion to develop plan in collaboration with ER/Trauma and plan in collaboration with ER/Trauma and hospital disaster planning committee hospital disaster planning committee hospital disaster planning committee hospital disaster planning committee

Utilize sample plans available

Collaborate with state/regional/local

fficials
fficials

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Radiologic Radiologic Disaster Plan Disaster Plan C 1 Components Components-

1

Roles of health care providers

Basic care concepts

Initial contact assessment

Initial contact, assessment,

Initial contact, assessment, decontamination decontamination

Medical stabilization

Documentation of history

E

iti / li i l E iti / li i l

Exposure recognition/clinical

Exposure recognition/clinical dosimetry dosimetry

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Radiologic Radiologic Disaster Plan Disaster Plan C 2 Components Components-

2

Classification and triage

Specific procedures based on levels of

Specific procedures based on levels of exposure/mixed injury exposure/mixed injury exposure/mixed injury exposure/mixed injury

Dealing with internal contamination

Maintaining security

Imaging

Imaging g g g g

Surgery/OR

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Radiologic Radiologic Disaster Plan Disaster Plan C 3 Components Components-

3

Radiologic team

Radiologic team-decontamination, decontamination,

Radiologic team

Radiologic team decontamination, decontamination, screening, monitoring screening, monitoring

Equipment

Psychosocial issues

Maintaining a safe environment

Specific roles for team members

R f

References

Forms for documentation

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Radiologic Radiologic Disaster Plan Disaster Plan C 4 Components Components-

4

Handling biological samples

Toxicity grading systems

Toxicity grading systems L l i l ti l t t L l i l ti l t t

Local, regional, national contacts

Telephone/beeper notification system for

Telephone/beeper notification system for deployment deployment

Drills

Post event review

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Cutaneous System

Symptom Symptom Degree 1 Degree 1 Degree 2 Degree 2 Degree 3 Degree 3 Degree 4 Degree 4

Cutaneous System

C Erythema Erythema1 minimal and transient minimal and transient moderate; isolated patches < moderate; isolated patches < 10cm 10cm2; not more than 10% of ; not more than 10% of body surface (BS) body surface (BS) marked; isolated patches or marked; isolated patches or confluent; 10 confluent; 10-

40% of BS

40% of BS Severe Severe2

2; isolated patches or

; isolated patches or confluent; >40% of BS confluent; >40% of BS Sensation/Itching Sensation/Itching pruritus pruritus slight and intermittent pain slight and intermittent pain moderate and persistent pain moderate and persistent pain severe and persistent pain severe and persistent pain Swelling/Edema Swelling/Edema present; asymptomatic present; asymptomatic symptomatic; tension symptomatic; tension secondary dysfunction secondary dysfunction total dysfunction total dysfunction Blistering Blistering rare, with sterile fluid rare, with sterile fluid rare, with hemorrhage rare, with hemorrhage bullae with sterile fluid bullae with sterile fluid bullae with hemorrhage bullae with hemorrhage Desquamation Desquamation absent absent patchy dry patchy dry patchy moist patchy moist confluent moist confluent moist Desquamation Desquamation absent absent patchy dry patchy dry patchy moist patchy moist confluent moist confluent moist Ulcer/Necrosis Ulcer/Necrosis epidermal only epidermal only dermal dermal subcutaneous subcutaneous muscle/bone involvement muscle/bone involvement Hair loss Hair loss thinning, not striking thinning, not striking patchy, visible patchy, visible complete and most likely complete and most likely complete and most likely complete and most likely reversible reversible irreversible irreversible Onycholysis Onycholysis absent absent partial partial partial partial complete complete

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International Journal of Radiation International Journal of Radiation O l Bi l d Ph i O l Bi l d Ph i Oncology, Biology and Physics Oncology, Biology and Physics

Vol. 65, No. 1Pages 16.e1
Vol. 65, No. 1Pages 16.e1-
16.e15 (01 May 2006)

16.e15 (01 May 2006)

Development of a statewide hospital plan for

Development of a statewide hospital plan for radiologic emergencies radiologic emergencies Ni h l Ni h l D i i k D i i k M D M D D i D i D lli C i i D lli C i i Ph D Ph D

Nicholas

Nicholas Dainiak Dainiak, M.D., , M.D., Domenico Domenico Delli Carpini Delli Carpini, Ph.D., , Ph.D., Michael Michael Bohan Bohan, B.S., , B.S., Michael Michael Werdmann Werdmann, M.D., , M.D., Edward Edward Wilds Wilds, Ph.D., , Ph.D., Agnus Agnus Barlow Barlow, M.S., , M.S., Ch l Ch l B k B k B S M S M A B S M S M A D id D id Ch Ch M D M D Charles Charles Beck Beck, B.S., M.S., M.A., , B.S., M.S., M.A., David David Cheng Cheng, M.D., , M.D., Nancy Nancy Daly Daly, M.S., M.P.H., , M.S., M.P.H., Peter Peter Glazer Glazer, M.D., , M.D., Peter Peter Mas Mas, M.S., , M.S., Ravinder Ravinder Nath Nath, Ph.D., , Ph.D., Gregory Gregory Piontek Piontek, , B S M S B S M S K th K th P i P i M P H /C H P M P H /C H P B.S., M.S., B.S., M.S., Kenneth Kenneth Price Price, M.P.H./C.H.P., , M.P.H./C.H.P., Joseph Joseph Albanese Albanese, Ph.D., , Ph.D., Kenneth Kenneth Roberts Roberts, M.D., , M.D., Andrew L. Andrew L. Salner Salner, M.D., , M.D., Sara Sara Rockwell Rockwell, Ph.D. , Ph.D.

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HOSPITAL RADIOLOGIC HOSPITAL RADIOLOGIC PREPAREDNESS TEAM PREPAREDNESS TEAM PREPAREDNESS TEAM PREPAREDNESS TEAM

Radiation oncologists

Medical physicists

Medical physicists R di ti f t ffi (h lth h i i t) R di ti f t ffi (h lth h i i t)

Radiation safety officer(health physicist)

Radiologists

Nuclear medicine personnel

Dosimetrists

Other trained radiologic staff

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HOSPITAL RADIOLOGIC HOSPITAL RADIOLOGIC PREPAREDNESS TEAM PREPAREDNESS TEAM PREPAREDNESS TEAM PREPAREDNESS TEAM

Organized with team leader(s)

Deployable and on

Deployable and on-

call for after hours

call for after hours deployment deployment deployment deployment

Readily available and calibrated survey

Readily available and calibrated survey t t l it t ti t t l it t ti meters, portal monitors, protective gear meters, portal monitors, protective gear

Knowledgeable of hospital disaster plan

Drills completed with ER/Trauma

Drills completed with ER/Trauma colleagues colleagues g

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SPECIALISTS SPECIALISTS NEEDED NEEDED NEEDED NEEDED

ER

TRAUMA

HEMATOLOGY

GI

INFECTIOUS DISEASE

CHAMPION, DEVELOP PLAN,

CHAMPION, DEVELOP PLAN, DRILL, DEPLOYMENT DRILL, DEPLOYMENT

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CT Radiation Response CT Radiation Response Pl i C itt Pl i C itt Planning Committee Planning Committee

Developed “Connecticut Model Radiation

Developed “Connecticut Model Radiation Emergency Manual for Hospitals” Emergency Manual for Hospitals” Emergency Manual for Hospitals Emergency Manual for Hospitals

Manual approved by state committees and

Manual approved by state committees and ultimately CT Public Health Preparedness and ultimately CT Public Health Preparedness and ultimately CT Public Health Preparedness and ultimately CT Public Health Preparedness and Advisory Committee Advisory Committee

Working to educate first responders

Working with bioterrorism tiers on preparedness,

Working with bioterrorism tiers on preparedness, drills drills E d ASTRO il t j t ff t E d ASTRO il t j t ff t

Endorses ASTRO pilot project efforts

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ASTRO pilot project ASTRO pilot project ASTRO pilot project ASTRO pilot project

R di ti E A i t R di ti E A i t

Radiation Emergency Assistance

Radiation Emergency Assistance Center/Training Site(REAC/TS) Center/Training Site(REAC/TS)-

Oak Ridge, TN

Oak Ridge, TN

Medical Management of Radiation Emergencies

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ASTRO pilot ASTRO pilot -

I

I p

Objectives

Each hospital in CT will have radiation preparedness Each hospital in CT will have radiation preparedness

Each hospital in CT will have radiation preparedness

Each hospital in CT will have radiation preparedness as part of its disaster plan as part of its disaster plan

Radiation Oncologists will be educated about this

Radiation Oncologists will be educated about this issue, become experts, educators, and champions in issue, become experts, educators, and champions in their institution/community their institution/community

Radiation Oncology staff(physics, dosimetry,

Radiation Oncology staff(physics, dosimetry, gy (p y , y, gy (p y , y, therapists) will be educated and involved therapists) will be educated and involved

Each hospital will have a plan for deploying staff for

Each hospital will have a plan for deploying staff for survey decontamination monitoring safety survey decontamination monitoring safety survey, decontamination, monitoring, safety survey, decontamination, monitoring, safety

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ASTRO pilot ASTRO pilot -II II ASTRO pilot ASTRO pilot II II

Small subcommittee developed 90 minute

Small subcommittee developed 90 minute t hi t f di ti l i t / t ff b d t hi t f di ti l i t / t ff b d teaching set for radiation oncologists/staff based teaching set for radiation oncologists/staff based

n REAC/TS course; also developed 45 minute
n REAC/TS course; also developed 45 minute

talk that trained radiation oncologists could talk that trained radiation oncologists could talk that trained radiation oncologists could talk that trained radiation oncologists could deliver to ER, general medical, nursing, and deliver to ER, general medical, nursing, and

ther hospital colleagues
ther hospital colleagues

p g p g

Educational products reviewed by Task Force

Educational products reviewed by Task Force members, REAC/TS staff, CT committee members, REAC/TS staff, CT committee

Final draft developed after broad input

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ASTRO pilot ASTRO pilot -III III ASTRO pilot ASTRO pilot III III

2 pilot lectures and 4 scheduled lectures for radiation

2 pilot lectures and 4 scheduled lectures for radiation p

ncologists/staff in CT
ncologists/staff in CT

Attempt to identify 1 radiation oncology “point person” in

Attempt to identify 1 radiation oncology “point person” in each hospital to assume responsibility for plan each hospital to assume responsibility for plan each hospital to assume responsibility for plan each hospital to assume responsibility for plan development development

Additional talks scheduled as needed in an attempt to

Additional talks scheduled as needed in an attempt to reach each and every hospital with radiation oncology reach each and every hospital with radiation oncology reach each and every hospital with radiation oncology reach each and every hospital with radiation oncology

Survey of all attending to assess content and

Survey of all attending to assess content and effectiveness of training instrument effectiveness of training instrument

Follow up survey with point persons to assess

Follow up survey with point persons to assess effectiveness of project and whether it is meeting its effectiveness of project and whether it is meeting its desired outcomes desired outcomes

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ASTRO pilot in Connecticut ASTRO pilot in Connecticut RESULTS RESULTS RESULTS RESULTS

Radiation oncologists and their staff

Radiation oncologists and their staff very very

Radiation oncologists and their staff

Radiation oncologists and their staff very very interested interested

80% hospitals represented at 6 scheduled

80% hospitals represented at 6 scheduled talks talks All h it l h d ith 4 t t lk All h it l h d ith 4 t t lk

All hospitals reached with 4 extra talks

All hospitals involved in enhancing their

All hospitals involved in enhancing their disaster plan disaster plan

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Radiation Oncologist Role Radiation Oncologist Role-I Radiation Oncologist Role Radiation Oncologist Role I

Develop team and deployment protocol in each

Develop team and deployment protocol in each hospital and DRILL hospital and DRILL hospital, and DRILL hospital, and DRILL

Develop protocol for radiation incidents with

Develop protocol for radiation incidents with ER/trauma planning team ER/trauma planning team ER/trauma planning team ER/trauma planning team

Educate team on radiation incidents/manual

Oversee deployment of team if incident occurs

Oversee deployment of team if incident occurs p y p y

Participate in screening, monitoring,

Participate in screening, monitoring, decontamination decontamination

Participate in triage of mixed injuries

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Radiation Oncologist Role Radiation Oncologist Role-II II Radiation Oncologist Role Radiation Oncologist Role-II II

Help to identify isotope, quantify dose, assess

Help to identify isotope, quantify dose, assess risk for each patient risk for each patient risk for each patient risk for each patient

Advise physician on diagnostic and therapeutic

Advise physician on diagnostic and therapeutic strategies strategies strategies strategies

Consult with hematologist concerning growth

Consult with hematologist concerning growth factors, other therapies factors, other therapies

Advise on short and long term risks and

Advise on short and long term risks and treatment strategies treatment strategies Ed t t ff di bli t f Ed t t ff di bli t f

Educate staff, media, public on nature of

Educate staff, media, public on nature of exposure and risk exposure and risk

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Radiation Oncologist Role Radiation Oncologist Role-III III Radiation Oncologist Role Radiation Oncologist Role III III

Develop screening strategy for “worried

Develop screening strategy for “worried well” well”

Provide conduit for information from State

Provide conduit for information from State agencies concerning radiation issues to agencies concerning radiation issues to Hospital Incident Command System and Hospital Incident Command System and staff staff staff staff

Serve as media expert for questions and

Serve as media expert for questions and answers answers answers answers

Assure safe environment in the hospital

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DRILL EXERCISE DRILL EXERCISE DRILL EXERCISE DRILL EXERCISE

salnernucraddrill.wmv

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Lessons from Hurricane Katrina Lessons from Hurricane Katrina August 2006 August 2006

Local providers may be on their own for

Local providers may be on their own for 4-

5 days after a disaster

5 days after a disaster

Medical Volunteers and Federal personnel will

Medical Volunteers and Federal personnel will ultimately arrive, may serve in harm’s way and ultimately arrive, may serve in harm’s way and perform care outside their specialty perform care outside their specialty p p y p p y

Disaster victims may be triaged and housed in

Disaster victims may be triaged and housed in large centers (stadiums), transported all over the large centers (stadiums), transported all over the country for medical care and housing country for medical care and housing

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Many good resources Many good resources Many good resources Many good resources

REMM

REMM- remm.nlm.gov remm.nlm.gov

REMM

REMM remm.nlm.gov remm.nlm.gov

AFRRI

AFRRI-

http://www.afrri.usuhs.mil/

http://www.afrri.usuhs.mil/

CDC

CDC http://www bt cdc gov/radiation/ http://www bt cdc gov/radiation/

CDC

CDC-http://www.bt.cdc.gov/radiation/ http://www.bt.cdc.gov/radiation/

DHS

DHS-

http://www dhs gov/xprepresp/programs/

http://www dhs gov/xprepresp/programs/ http://www.dhs.gov/xprepresp/programs/ http://www.dhs.gov/xprepresp/programs/

DHHS

DHHS-

http://www hhs gov/disasters/emergency/

http://www hhs gov/disasters/emergency/ http://www.hhs.gov/disasters/emergency/ http://www.hhs.gov/disasters/emergency/ manmadedisasters/radiation/index.html manmadedisasters/radiation/index.html

REAC/TS

REAC/TS-http://orise orau gov/reacts/ http://orise orau gov/reacts/

REAC/TS

REAC/TS-http://orise.orau.gov/reacts/ http://orise.orau.gov/reacts/

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SUMMARY SUMMARY-1 SUMMARY SUMMARY 1

THE THREAT OF A NUCLEAR/RADIOLOGIC

THE THREAT OF A NUCLEAR/RADIOLOGIC EVENT IS REAL! EVENT IS REAL!

ALL EVENTS ARE LOCAL! NEED

ALL EVENTS ARE LOCAL! NEED COORDINATED LOCAL RESPONSE IN A COORDINATED LOCAL RESPONSE IN A SYSTEM THAT IS ALREADY STRESSED SYSTEM THAT IS ALREADY STRESSED

RADIOLOGIC RESPONSE TEAM AT EACH

RADIOLOGIC RESPONSE TEAM AT EACH HOSPITAL CAN HELP AND IS ESSENTIAL IN HOSPITAL CAN HELP AND IS ESSENTIAL IN COMPLETING THE PREPAREDNESS COMPLETING THE PREPAREDNESS COMPLETING THE PREPAREDNESS COMPLETING THE PREPAREDNESS EFFORTS OF OUR HOSPITALS EFFORTS OF OUR HOSPITALS

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SUMMARY 2 SUMMARY 2 SUMMARY 2 SUMMARY 2

RADIATION ONCOLOGIST NATURAL

RADIATION ONCOLOGIST NATURAL TEAM LEADER/CHAMPION TEAM LEADER/CHAMPION

COORDINATION IN HOSPITAL AND

COORDINATION IN HOSPITAL AND COMMUNITY NEEDED COMMUNITY NEEDED

RADIATION INJURY IS TREATABLE

MORAL IMPERATIVE FOR US TO

MORAL IMPERATIVE FOR US TO CONTRIBUTE TO OUR HOSPITAL AND CONTRIBUTE TO OUR HOSPITAL AND CONTRIBUTE TO OUR HOSPITAL AND CONTRIBUTE TO OUR HOSPITAL AND COMMUNITY COMMUNITY-

THE RIGHT

THE RIGHT THING TO DO! THING TO DO! THING TO DO! THING TO DO!

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THANK YOU! THANK YOU! THANK YOU! THANK YOU!

Each of us individually is but a drop of

Each of us individually is but a drop of water, together we are an ocean! water, together we are an ocean!