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  • 1. Tools for Medical Planners and Responders to Use in Radiation Mass Casualty Events CAPT Judith L. Bader, ASPR and NCI CAPT Jeffrey Nemhauser, CDC USPHS Scientific and Training Symposium Medical Category Day Atlanta, GA June 2, 2009
  • 2. Why you should care
    • Certain rad/nuc events c(w)ould be big problems.
    • There is much that can be done.
    • We all could be called up to serve: IND
    • Understanding the problem helps you help yourself, your patients and other responders
    • The tools shown will help you prepare and respond.
    • Big problem Very big problem But still focal
  • 3.  
  • 4. Lots of responsibilities… so little time
    • Scenario 1: Nuclear Detonation – 10-Kiloton Improvised Nuclear Device
    • Scenario 2: Biological Attack – Aerosol Anthrax
    • Scenario 3: Biological Disease Outbreak – Pandemic Influenza
    • Scenario 4: Biological Attack – Plague
    • Scenario 5: Chemical Attack – Blister Agent
    • Scenario 6: Chemical Attack – Toxic Industrial Chemicals
    • Scenario 7: Chemical Attack – Nerve Agent
  • 5.
    • Scenario 8: Chemical Attack – Chlorine Tank Explosion
    • Scenario 9: Natural Disaster – Major Earthquake
    • Scenario 10: Natural Disaster – Major Hurricane
    • Scenario 11: Radiological Attack – Radiological Dispersal Devices
    • Scenario 12: Explosives Attack – Bombing Using Improvised Explosive Devices
    • Scenario 13: Biological Attack – Food Contamination
    • Scenario 14: Biological Attack – Foreign Animal Disease (Foot and Mouth Disease)
    • Scenario 15: Cyber Attack
    http://media.washingtonpost.com/wp-srv/nation/nationalsecurity/earlywarning/NationalPlanningScenariosApril2005.pdf Lots of responsibilities… so little time
  • 6.
  • 7. About REMM: http://remm.nlm.gov
    • Radiation Event Medical Management: (REMM)
    • HHS/ASPR funded beginning July 2005
    • Launched by HHS Secretary March 2007
    • Weekly content updates, enhancements
    • REMM Team: NCI, CDC, NLM
    • Dozens of national and international reviewers
  • 8.
    • Provide guidance for health care providers, primarily physicians , about clinical diagnosis and treatment during mass casualty radiological and nuclear events
    • Provide just-in-time, evidence-based, usable information with sufficient background and context to make complex issues understandable to those without formal radiation medicine expertise
    • Provide web-based information that is also downloadable in advance, so that it would be available during an event if the internet is not accessible: online version, mobile version
    Goals of REMM: http://remm.nlm.gov
  • 9.
    • What kinds of events?
    • What is exposure? What is contamination? -- Algorithms for diagnosis and treatment -- Calculator to estimate dose from exposure
    • Up to date evidence for clinical recommendations
    • Introduction to Radiation Emergency Medicine
    • Isotopes of concern and countermeasures
    • Creating/equipping medical response teams
    • Distilled information, with links to long guidance documents
    • Bibliography, dictionary, much more..
    Content : http://remm.nlm.gov
  • 10.
    • Entire site downloadable
    • Mobile device version
    • Simple, effective navigation
    • Plain language
    • Searchable
    • Many videos and graphics to illustrate complex concepts and procedures
    • PubMed hyperlinks to cited articles
    Style and function: http://remm.nlm.gov
  • 11.
    • Update of dose estimator for exposure : (June 2009)
    • --Time to onset of vomiting --Lymphocyte depletion kinetics
    • Multi-organ Dysfunction Syndrome : (May 2009) --Multi-organ injury, multi-organ dysfunction syndrome, multi-organ failure: a new view of whole body radiation effects
    • How to Use Radiation Survey Meters--Videos from CDC : --Screening people for external contamination: how to use hand-held radiation survey equipment (May 2009)
    Updates to REMM: http://remm.nlm.gov
  • 12.
    • Perform Lifesaving Tasks Before Managing Radiation Problems --New text on all patient management algorithms (May 2009)
    • Online Radiation Courses --Basic radiation biology and effects of exposure to radiation (May 2009)
    • Initial Onsite Activities --Radiation Response Worker Exposure Guides (PAGs) in the Early Phase (February 2009)
    Updates to REMM: http://remm.nlm.gov
  • 13.
    • Triage Guidelines --Links to new radiation and mass casualty triage categories (February 2009)
    • Planning Guidance for Response to a Nuclear Detonation --Homeland Security Council, (January 2009)
    • Download Mobile REMM --REMM for Blackberries, Windows Mobile, and Palm (December 2008, June 2009)
    • Cutaneous Radiation Syndrome --Descriptions, many photographs (August 2008)
    Updates to REMM: http://remm.nlm.gov
  • 14.
    • REMM Quick Tour --Video: finding information on REMM (August 2008)
    • Radiation Effects on Blood Counts --How blood counts respond to radiation exposure: graphs (August 2008)
    • Time Phases of Acute Radiation Syndrome --Relationship between radiation dose and signs/symptoms of the Acute Radiation Syndrome (August 2008)
    Updates to REMM: http://remm.nlm.gov
  • 15.
    • Files [>300 ], Videos [ 7 ], Still graphics [ 318 ]
    • Monthly page views [ >550 K ]
    • Monthly unique visits [ 175 K ]
    • Downloads of site in last 6 months
      • Windows [ 3000 ] , Mac OS [ 360 ]
    • Downloads of mobile version
      • Blackberry [ 1142 ], Windows Mobile [ 225 ], Palm [ 200 ]
    • Links to REMM from external sites [ 1063 ]
    • ListServ members [ 572 ]
    • USB drives distributed with ListServ encouragement
    • Request for similar web portal by GHSAG Rad/Nuc WG
    Data for REMM: http://remm.nlm.gov
  • 16. Other Rad/Nuc software tools
    • Overview of Hazard Assessment and Emergency Planning Software of Use to Radiological/Nuclear (RN) First Responders
      • Edward Waller; Kyle Millage; William Blakely; James Ross; John Mercier; David Sandgren; Ira Levine; William Dickerson; Jeffrey Nemhauser ; John Nasstrom; Gayle Sugiyama; Steve Homann; Brooke Buddemeier; Carl Curling; Deena Disraelly
    • In press: Health Physics
  • 17. http://remm.nlm.gov Demo by Dr. Nemhauser