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Radiological and Nuclear
Topic Collection
February 1, 2024

Topic Collection: Radiological and Nuclear

A large-scale radiological release or nuclear detonation incident could result in a significant surge of patients, including those who may not have actually been exposed, but seek medical attention anyway. Power plant incidents, radiation dispersion devices, and improvised nuclear device detonations result in very different injury/exposure patterns and response planning will need to account for each of these. Patients exposed to radiation may simply be “irradiated” (gamma waves pass through them without any direct material on/in the patient) or can be “contaminated” if internal or external radioactive material is present. Both exposures result in dose-dependent damage to body tissues. In most cases of radiation dispersion devices, the risk of injury is very low, but in nuclear device detonations large numbers of patients may have acute radiation illness and require evaluation and treatment. The resources in this Topic Collection include toolkits, reference guides, plan guidance documents, modeling and simulation reports, and manuals that may help first responders and first receivers assess, triage, and treat casualties of radiological and nuclear emergencies. This Topic Collection was updated in August 2021.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category. (Please note: this Topic Collection does not include a comprehensive overview of responder health and safety issues. Please refer to the Responder Safety and Health and Decontamination Topic Collections for related information.)

"Must Reads" were chosen by Subject Matter Experts based on their overall value and the material covered. However, knowledge about Acute Radiation Syndrome (ARS) and patient management has evolved rapidly and prior conclusions about time to onset of vomiting and its correlation with toxicity as well as management of ARS patients may not reflect current practice. Readers are encouraged to use these resources as a starting point and seek specific assessment and treatment recommendations from websites such as the U.S. Department of Health and Human Services Radiation Emergency Medical Management (REMM). 

Must Reads


In this ASPR TRACIE webinar, experts shared tips on assessing, triaging, treating, and following-up with patients affected by radiological and nuclear emergencies. Strategies for handling the initial surge of patients and planning for community reception centers were also discussed.
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The 2019-2023 HPP Funding Opportunity Announcement (FOA) requires healthcare coalitions (HCCs) to develop a complementary coalition-level radiation emergency surge annex to their base medical surge/trauma mass casualty response plan. This annex aims to improve capacity and capabilities to manage exposed or potentially exposed patients during a radiation emergency.
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This ASPR TRACIE document provides an overview of the potential health and medical response and recovery needs following a radiological or nuclear incident and outlines available resources for planners.
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Bomanji, J.B., Novruzov, F., and Vinjamuri, S. (2014). Radiation Accidents and Their Management: Emphasis on the Role of Nuclear Medicine Professionals. Nuclear Medicine Communications. 35(10):995-1002.
This article summarizes protocols for decontaminating, assessing, and treating casualties of radiation accidents, and advocates for nuclear medicine specialists to be part of the multidisciplinary care team for these patients. Several relevant tables are also provided in the article.
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This article discusses the Radiation Injury Treatment Network (RITN), a cooperative effort of the National Marrow Donor Program and the American Society for Blood and Marrow Transplantation. RITN educates hematologists, oncologists, and stem cell transplant specialists to treat casualties of radiation emergencies. RITN members are transplant units within hospitals across the nation available to provide surge capacity by transferring patients, or by having practitioners provide medical expertise in person or remotely to health care facilities caring for patients with marrow toxic injuries.
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Centers for Disease Control and Prevention. (2019). Radiation Emergencies: Information for Professionals.
This webpage contains links to resources for clinicians treating victims of radiation emergencies, public health preparedness capabilities, and information for radiological terrorism planning.
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DiCarlo, A.L., Maher, C., Hick, J.L. et al. (2011). Radiation Injury After a Nuclear Detonation: Medical Consequences and the Need for Scarce Resources Allocation. Disaster Medicine and Public Health Preparedness. Volume 5. Supplement 1.
This literature review focuses on radiation injuries from human exposures and animal models and is accompanied by various triage and management approaches (covered in the rest of this special issue).
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Federal Emergency Management Agency. (2022). Planning Guidance for Response to a Nuclear Detonation. Third Edition. Homeland Security Council Interagency Policy Coordination Subcommittee for Preparedness and Response to Radiological and Nuclear Threats.
This core resource document provides emergency planners (including emergency medical service planners, medical receiver planners, and mass care providers) recommendations specific to nuclear detonation incidents in an urban setting.
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This document lists five Missions and Tactics that should be carried out by first responders, emergency managers, and other response organizations just after a nuclear detonation in or near their jurisdiction. Each tactic is accompanied by a short checklist and annexes on radiation exposure detection, response, and triage are included.
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Hick, J.L., Weinstock, D.M., Coleman, C.N. et al. (2011). Health Care System Planning for and Response to a Nuclear Detonation. Disaster Medicine and Public Health Preparedness. Volume 5. Supplement 1.
The authors use vignettes to describe how a nuclear the incident may unfold for the various components of the health and medical systems. They also emphasize the need for first responders to protect themselves physically and psychologically.
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Oak Ridge Institute for Science and Education. (2021). Radiation Emergency Assistance Center/Training Site.
This webpage links to the Radiation Emergency Assistance Center/Training Site (REAC/TS), which offers several resources to prepare medical professionals to respond to radiological emergencies. There are links to books, live training courses, online trainings, and assessment and treatment guidance documents. REAC/TS staff are available for deployment to provide medical consultation during emergencies, upon request.
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Turai, I., Veress, K., Günalp, B, and Souchkevitch, G. (2004). Medical Response to Radiation Incidents and Radionuclear Threats. British Medical Journal 328(7439):568-72.
The authors provide information on the basic medical management of radiation sickness and radiation injuries, and share information about related training on early recognition of and medical response to radiation accidents and purposeful incidents.
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U.S. Department of Health and Human Services. (2021). Radiation Emergency Medical Management. (Homepage.)
This webpage provides guidance on diagnosis and treatment for healthcare providers. It includes downloadable tools, templates, references, and contact lists. Several REMM resources (e.g., downloadable tools, calculators, and templates) are included in this Topic Collection.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2012). Medical Planning and Response Manual for a Nuclear Detonation Incident: A Practical Response Guide.
This comprehensive document provides emergency planners with information not only on the effects of radiation and how to measure and treat them, but also on how to communicate during a radiological or nuclear emergency. It also describes federal response roles and the distribution of medical countermeasures for acute radiation sickness in an environment of scarce resources.
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Washington State Department of Health. (n.d.). State Radiological Emergency Preparedness Agencies. (Accessed 6/15/2021.)
This webpage provides links to each U.S states specific radiological emergency preparedness agency or organization. This streamlined list provides a way to identify each state’s radiation public health page along with contract information and resources.
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Wolbarst, A.B., Wiley, A.L. Jr., Nemhauser, J.B. et al. (2010). Medical Response to a Major Radiologic Emergency: A Primer for Medical and Public Health Practitioners. Radiology. 254(3):660-77.
This article reviews the types of radiation incidents and the radiation injuries that would be sustained by casualties of a nuclear or radiologic device detonation, or accidental release, such as from a power plant, as well as how to treat them. It also describes the important role physicians who understand the effects of radiation on the human body and how to treat them, will play during a radiological or nuclear emergency.
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Clinical Guidance


Armed Forces Radiobiology Institute. (2013). Medical Management of Radiological Casualties.
This document provides guidance on medical management of casualties resulting from a radiological event in the first 72 hours. Three scenarios are presented with specific information on personnel protection, radiation effects, and phases of Acute Radiation Syndrome (ARS).
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In this ASPR TRACIE webinar, experts shared tips on assessing, triaging, treating, and following-up with patients affected by radiological and nuclear emergencies. Strategies for handling the initial surge of patients and planning for community reception centers were also discussed.
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This ASPR TRACIE document provides an overview of the potential health and medical response and recovery needs following a radiological or nuclear incident and outlines available resources for planners.
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Bomanji, J.B., Novruzov, F., and Vinjamuri, S. (2014). Radiation Accidents and Their Management: Emphasis on the Role of Nuclear Medicine Professionals. Nuclear Medicine Communications. 35(10):995-1002.
This article summarizes protocols for decontaminating, assessing, and treating casualties of radiation accidents, and advocates for nuclear medicine specialists to be part of the multidisciplinary care team for these patients. Several relevant tables are also provided in the article.
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Centers for Disease Control and Prevention. (2017). Determining Deaths from a Radiation Emergency.
This webpage can help medical examiners, coroners (and emergency healthcare providers, planners, and responders) better understand radiation scenarios that may cause death and related illnesses and injuries that may cause death.
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This webpage provides guidance on chelating agents for treating internal contamination and FDA approved cytokines for acute radiation syndrome.
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* Centers for Disease Control and Prevention. (2018). Radiation Emergencies: Information for Clinicians.
This webpage provides links to information on patient management, guidelines and recommendations, training, and the “Radiological Terrorism: Toolkit for Emergency Services Clinicians.”
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Coleman, C.N. and Koerner, J.F. (2016). Biodosimetry: Medicine, Science, and Systems to Support the Medical Decision-Maker Following a Large Scale Nuclear or Radiation Incident. (Abstract only.) Radiation Protection Dosimetry. 172:38-46.
The authors share how biodosimetry assays can help healthcare providers provide medical evaluation and care in a radiological or nuclear incident.
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Coleman, C.N., Sullivan, J.M., Bader, J.L., et al. (2015). Public Health and Medical Preparedness for a Nuclear Detonation: The Nuclear Incident Medical Enterprise. Health Physics. 108:149-160.
The authors summarize Nuclear Incident Medical Enterprise (NIME), the approach developed by the U.S. Department of Health and Human Services by both government and non-government experts. NIME can be used by emergency healthcare planners to support planning for, responding to, and recovering from the effects of a nuclear incident.
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The author summarizes recommendations made at a World Health Organization meeting in 2009. Participants discussed clinical management of acute radiation syndrome based on a scenario involving the hospitalization of 100–200 victims.
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Dainiak, N., Gent, R.N., Carr, Z., et al. (2011). First Global Consensus for Evidence-Based Management of the Hematopoietic Syndrome Resulting from Exposure to Ionizing Radiation. Disaster Medicine and Public Health Preparedness. 5(3):202-12.
A panel convened by the World Health Organization conducted a literature review to develop evidence-based guidelines for the management of hematopoietic syndrome resulting from exposure to ionizing radiation. Although the panel determined the evidence was weak, members strongly recommended granulocyte colony-stimulating factor or granulocyte macrophage colony-stimulating factor. The use of erythropoiesis-stimulating agents or hematopoietic stem cell transplantation was less strongly supported by the evidence.
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Fang, Z., Chen, P., Tang, S. et al. (2021). Will Mesenchymal Stem Cells be Future Directions for Treating Radiation-Induced Skin Injury? Stem Cell Research and Therapy. 12:179.
he authors discuss the application of mesenchymal stem cells (MSCs) to radiation-induced skin injuries (RISI). Specifically, the authors review the different sources of MSCs on treatment and summarize its application in other studies.
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This discussion paper describes the screening function (Exposure And Symptom Triage – EAST) which will primarily be conducted at Assembly Centers after a nuclear detonation. Geared towards jurisdictional emergency planners and responders as a planning reference, it contains response tools and strategies that will assist them in planning for Assembly Centers and mass screening functions.
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Hofer, M., Pospisil, M., Komurkova, D., et al. (2014). Granulocyte Colony-Stimulating Factor in the Treatment of Acute Radiation Syndrome: A Concise Review. Molecules. 19(4):4770-4778.
This article reviews data on the use of granulocyte colony-stimulating factor (G-CSF) to treat accidental radiation exposure resulting in acute radiation syndrome. The article discusses timing of use, combination therapies, and action on gastrointestinal radiation syndrome.
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* Institute for Disaster Mental Health at SUNY New Paltz. (n.d.). Disaster Mental Health: Assisting People Exposed to Radiation. (Accessed 6/15/2021.)
This document was developed for the New York State Department of Health to address mental health needs of first responders and victims exposed to radiation. The training guide provides information related to identifying psychosocial issues, maintaining the mental health of emergency response personnel, and understanding self-care and intervention practices. Access the related presentation: https://portal.ct.gov/-/media/DMHAS/Publications/DMHRadiationXposurepdf.pdf.
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This document can help emergency healthcare providers learn more about medically managing patients who have been internally contaminated through inhalation, ingestion or absorption of radionuclides in a nuclear or radiological emergency. It includes several scenarios and sample data that can be adapted to suit a facility's or jurisdiction's needs.
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Meit, M., Redlener, I., Briggs, T.W. et al. (2011). Rural and Suburban Population Surge Following Detonation of an Improvised Nuclear Device: A New Model to Estimate Impact. Disaster Medicine and Public Health Preparedness. Volume 5. Supplement 1.
The authors describe a “push-pull” model that estimated the evacuation from Manhattan to counties within a 150 mile radius after a nuclear detonation. This model predicted that arriving evacuees could increase the population needing services by between 50 and 150 percent.
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Oak Ridge Institute of Science and Education (ORISE). (n.d.). Resources for Medical Professionals. (Accessed 5/12/2021.)
This webpage provides resource aids for the medical response and treatment of persons exposed to ionizing radiation. Included are links to information on radiation accident management, dose estimation, and radiation countermeasures.
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Radiation Emergency Assistance Center/Training Site. (2020). Radiation Patient Treatment.
This algorithm can help healthcare providers make quick triage decisions regarding extent of injury when treating patients exposed to or contaminated by radiological hazards.
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Radiation Emergency Medical Management. (2021). Diagnosis and Treatment.
This webpage provides information on diagnosing and treating radiation exposure related to subsyndromes, contamination isotopes of interest, and countermeasures.
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Radiation Emergency Medical Management. (2021). Hospital Activities During Radiation Emergencies.
This webpage includes links to resources hospital planners can review to improve preparedness for and response to a radiation incident.
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Radiation Emergency Medical Management. (2021). Interactive Tools for Managing Patients in Radiation Emergencies.
This webpage provides comprehensive guidance and tools for managing patients with radiation exposure that include triage guidelines, managing ARS subsyndromes, and using algorithms for assessing contamination.
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* Radiation Emergency Medical Management. (2021). Nuclear Detonation: Weapons, Improvised Nuclear Devices.
This webpage provides a variety of information and resources for managing and responding to a nuclear detonation. Resources include general nuclear detonation information, a timeline of events, categories of medical effects, medical management protocol, sheltering in place guidance, and best practice for communications during a disaster.
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This webpage provides an evaluation tool for assessing proper treatment protocol for Acute Radiation Syndrome (ARS). Information includes estimating dose from exposure, first stages of evaluation and management, as well as special issues such as scarce resources and multi-organ dysfunction.
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Radiation Injury Treatment Network. (2016). Acute Radiation Syndrome Treatment Guidelines.
This PowerPoint presentation highlights treatment guidelines healthcare practitioners can apply in the event of a nuclear detonation. Information includes principles of Acute Radiation Syndrome (ARS) management (and timing and severity of symptoms); altered standards/crisis standards of care; and patient triage and casualty profiles.
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Ryan, J.L. (2012). Ionizing Radiation: The Good, the Bad, and the Ugly. Journal of Investigative Dermatology. 132(3 Pt 2):985-93.
The author describes the effects of ionizing radiation on the skin, and includes a concise description of how radiation burns manifest, noting how they differ from other burns and why this causes treatment challenges. She concludes after a literature review that there is no “gold standard” for assessing and treating radiation skin injury.
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Singh, V.K., Newman, V.L., Romaine, P.L., et al. (2014). Radiation Countermeasure Agents: An Update (2011-2014). Expert Opinion on Therapeutic Patents. 24(11):1229-55.
This article provides an extensive review of existing radiation countermeasures, as well as those under development and/or being considered for Emergency Use Authorization status by the federal Food and Drug Administration.
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* Turai, I., Veress, K., Günalp, B, and Souchkevitch, G. (2004). Medical Response to Radiation Incidents and Radionuclear Threats. British Medical Journal 328(7439):568-72.
The authors provide information on the basic medical management of radiation sickness and radiation injuries, and share information about related training on early recognition of and medical response to radiation accidents and purposeful incidents.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2012). Medical Planning and Response Manual for a Nuclear Detonation Incident: A Practical Response Guide.
This comprehensive document provides emergency planners with information not only on the effects of radiation and how to measure and treat them, but also on how to communicate during a radiological or nuclear emergency. It also describes federal response roles and the distribution of medical countermeasures for acute radiation sickness in an environment of scarce resources.
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This guidance can help preserve responder health and safety in the event of a 10 kiloton improvised nuclear device within the first 72 hours of a detonation and is one of the few sources of information for advice about scene hazard control /mitigation and environmental considerations.
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* Various Authors. (2011). Disaster Medicine and Public Health Preparedness. Volume 5. Supplement 1.
This special issue contains articles highlighting the work of the Nuclear Detonation Scarce Resources Project Working Group. Included are discussions of triage and medical management of casualties resulting from nuclear detonations; social and behavioral response considerations for planners; and guidance to support health care system preparedness to respond to a nuclear detonation.
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Wang, M., Xu, X., Lei, Xiongxin., et al. (2021). Mesenchymal Stem Cell-Based Therapy for Burn Wound Healing. Burns and Trauma. 9..
This article reviews animal studies and clinical trials related to use of mesenchymal stem cell-based therapy for burn wound healing. The authors review differing mechanisms of application, highlight positives and negatives of each, and provide recommendations for improvement.
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Wolbarst, A.B., Wiley, A.L. Jr., Nemhauser, J.B. et al. (2010). Medical Response to a Major Radiologic Emergency: A Primer for Medical and Public Health Practitioners. Radiology. 254(3):660-77.
This article reviews the types of radiation incidents and the radiation injuries that would be sustained by casualties of a nuclear or radiologic device detonation, or accidental release, such as from a power plant, as well as how to treat them. It also describes the important role physicians who understand the effects of radiation on the human body and how to treat them, will play during a radiological or nuclear emergency.
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Education and Training


The goal of this hour-long training was to increase the knowledge base among emergency and disaster response personnel, as well as the general public, about the probability, effects, and consequences of radiological disasters and the importance of clear risk communication before, during, and after an incident.
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Blumenthal, D.J., Bader, J.L., Christensen D., et al. (2014). A Sustainable Training Strategy for Improving Health Care Following a Catastrophic Radiological or Nuclear Incident. (Abstract only.) Prehospital and Disaster Medicine. 29(1):80-6.
The authors propose a training strategy that includes all members of the health care delivery team, from first responders to first receivers and hospital support staff, and divides them into four tiers for targeting educational strategies. These strategies are capabilities-driven, and include the addition of radiological and nuclear-focused modules to existing trainings; the incorporation of radiation contamination measures into everyday practice; and providing just-in-time training at the time of an event.
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Center for Domestic Preparedness. (n.d.). Homeland Security Radiological Emergency Preparedness Program (REPP). (Accessed 5/13/2021.)
REPP supports the coordination of state, local, and tribal officials with planning and training for incidents involving commercial nuclear power plants (NPPs). Courses include radiological emergency management, accident assessment, and plume planning. Hospitals in areas with nuclear power plants should be aware of the required planning including community-based assessment and decontamination centers.
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Centers for Disease Control and Prevention. (2014). Radiation Basics Made Simple.
Radiation Basics Made Simple is a training module that introduces participants to the fundamentals of radiation and radioactivity.
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Centers for Disease Control and Prevention. (2015). Medical Countermeasures for Radiation Exposure and Contamination.
Medical Countermeasures for Radiation Exposure and Contamination is a training module that aids in better understanding what medical countermeasures (treatments) are available for radiation exposure and contamination, how they work, and how and when they should be used.
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* Centers for Disease Control and Prevention. (2018). Radiation Emergencies: Information for Clinicians.
This webpage provides links to information on patient management, guidelines and recommendations, training, and the “Radiological Terrorism: Toolkit for Emergency Services Clinicians.”
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Centers for Disease Control and Prevention. (2018). Radiation Emergency Training, Education and Tools.
This webpage offers links to educational videos, resource tools, online training modules, and webinars designed to prepare public health and healthcare professionals to respond to radiation emergencies and disasters.
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Centers for Disease Control and Prevention. (2019). Communication for a Nuclear or Radiological Disaster.
This webinar presents information from top experts on how to communicate during a nuclear or radiological emergency. It includes information on discussing misunderstandings, how the event will affect populations, and actions to take and avoid.
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This webpage provides information related to assessing and monitoring population exposure during a radiological incident. Included are guidance and planning tools, resource guides, and toolkits for operating community reception centers.
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Centers for Disease Control and Prevention. (2021). Radiation Risk Communication for Public Health.
This video provides guidance and best practices for communicating with the public during a radiological disaster.
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Centers for Disease Control and Prevention. (2023). This is a T.E.S.T. (Tabletop Exercise Simulation Tool).
The Centers for Disease Control and Prevention created this tool to help emergency preparedness and response partners who may be involved in post-radiation incident population monitoring. "This is a T.E.S.T." is a game that uses operational exercises and narrative-based problems to improve teamwork, understand resource management, and aid in understanding specific roles and responsibilities during a radiation emergency.
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* Centers for Disease Control and Prevention, Emergency Preparedness and Response. (2015). Virtual Community Reception Center (vCRC).
This web-based training tool teaches emergency healthcare planners how to conduct population monitoring after a mass casualty radiation emergency in community reception centers.
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* Crouch, G., Schor, K., and Fitzgerald, T. (2013). Radiation Issues in Children: Knowledge Check, Primer, & Case-Based Activity. National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences.
This webpage provides links to a knowledge check, primer, and case studies on radiation issues in children.
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* Institute for Disaster Mental Health at SUNY New Paltz. (n.d.). Disaster Mental Health: Assisting People Exposed to Radiation. (Accessed 6/15/2021.)
This document was developed for the New York State Department of Health to address mental health needs of first responders and victims exposed to radiation. The training guide provides information related to identifying psychosocial issues, maintaining the mental health of emergency response personnel, and understanding self-care and intervention practices. Access the related presentation: https://portal.ct.gov/-/media/DMHAS/Publications/DMHRadiationXposurepdf.pdf.
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This document can help emergency healthcare providers learn more about medically managing patients who have been internally contaminated through inhalation, ingestion or absorption of radionuclides in a nuclear or radiological emergency. It includes several scenarios and sample data that can be adapted to suit a facility's or jurisdiction's needs.
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Lawrence Livermore National Laboratory. (n.d.). Training for Nuclear and Radiological Response.
This narrated, self-guided course can help students learn more about basic modeling concepts specific to radiological and nuclear release scenarios. The course covers plume dispersion and using dose models in emergency planning and response.
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National Alliance for Radiation Readiness. (2019). Radiation Training Modules for Public Health.
This webpage provides links to several training webinars that are designed to help education new public health preparedness professionals on radiological/nuclear preparedness. Training modules are broken out by hours before and after an incident.
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* National Center for Environmental Health: Radiation Studies Branch. (2011). Detonation of an Improvised Nuclear Device.
This social media message planning resource summarizes the findings of the Nuclear Detonation Response Communications Working Group during their analysis of messaging and communication in the aftermath of a nuclear incident. In their study, six 90-minute focus groups analyzed an array of different messaging examples for relevance, comprehensibility, and credibility. Results gathered highlight the effectiveness of the messaging and provide useful lessons learned and best practices for future communications initiatives.
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National Security Technologies. (n.d.). Center for Radiological and Nuclear Training at the Nevada National Security Site. (Accessed 7/26/2021.)
This website links to training for radiological and nuclear response (e.g., AWR-140-W and courses on improvised nuclear devices). Both online and in-person courses are available free of charge to qualified individuals.
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Oak Ridge Institute for Science and Education. (n.d.). Procedure Demonstrations for Contaminated Patients. (Accessed 8/9/2021.)
These video demonstrations show healthcare providers how to: dress to prevent the spread of radioactive contamination; remove contaminated clothing from a patient; decontaminate a wound; and decontaminate intact skin. Note that some illustrations may not reflect current recommended practices but the principles remain solid.
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Oak Ridge Institute for Science and Education. (n.d.). Understanding Radiation Video Series. (Accessed 8/9/2021.)
These short videos can help health officials and the public better understand radiation and radioactive contamination.
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Oak Ridge Institute for Science and Education (ORISE). (n.d.). Radiation Emergency Assistance Center/Training Site (REAC/TS). (Accessed 7/12/2018.)
This webpage links to the Radiation Emergency Assistance Center/Training Site (REAC/TS), which offers several resources to prepare medical professionals to respond to radiological emergencies. There are links to books, live training courses, online trainings, and assessment and treatment guidance documents. REAC/TS staff are available for deployment to provide medical consultation during emergencies, upon request.
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Radiation Emergency Medical Management. (2018). Radiation Incidents: Multimedia Library.
These illustrations, short videos, and other forms of media can help emergency healthcare preparedness planners how to discover a radiation incident; characterize severity; create a timeline; understand different types of incidents (including nuclear explosions); and communicate with the public in the event of an incident.
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Radiation Injury Treatment Network. (2019). Training Materials.
This web page includes links to RITN training courses for medical and non-medical staff, and include just-in-time training, the RITN YouTube channel, and relevant CDC and FEMA EMI courses.
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* Radiation Injury Treatment Network. (2021). Exercises.
This webpage provides multiple hospital preparedness exercises for a nuclear or radiological emergency and including all materials necessary to conduct full-scale, functional and tabletop exercises.
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Radiation Injury Treatment Network. (2021). Healthcare Coalition Functional Radiation Exercise.
This HSEEP compliant functional exercise kit can help healthcare providers address the operational elements of the receipt, triage, and care of radiation-injury and acute blast/burn injury casualties in accordance with existing healthcare coalition and individual hospital/agency plans.
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Southern Regional Disaster Response System. (2023). SRDRS Rad/Nuc Emergency Webinar Series.
This series of webinars covers various healthcare system and public health implications for radiological/nuclear scenarios. Links to YouTube videos and handouts are provided for each webinar.
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* Turai, I., Veress, K., Günalp, B, and Souchkevitch, G. (2004). Medical Response to Radiation Incidents and Radionuclear Threats. British Medical Journal 328(7439):568-72.
The authors provide information on the basic medical management of radiation sickness and radiation injuries, and share information about related training on early recognition of and medical response to radiation accidents and purposeful incidents.
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Event-Specific Lessons Learned


This report details the role of the federal government in helping cities and states clean up after terror attacks using a radiological dispersal device or improvised nuclear device. Recovery activities after the 2006 United Kingdom (UK) polonium incident and the UK Nuclear Recovery Plan Template are also discussed.
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Becker, S. (2013). The Fukushima Dai-Ichi Accident: Additional Lessons from a Radiological Emergency Assistance Mission. (Abstract only.) Health Physics. 105(5): 455–461.
The author describes response and recovery lessons learned by team members (including an emergency physician, health physicist, and a disaster management specialist) who spent 10 days conducting fieldwork in areas affected by the incident.
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Bromet, E. (2014). Emotional Consequences of Nuclear Power Plant Disasters. Health Physics. 106(2): 206-210.
This article describes the emotional consequences and resilience of two groups of nuclear power plant disaster survivors: mothers of young children and nuclear plant workers. The authors stress the need for considering physical and mental health "in an integrated fashion," the need for more long-term research, and the need for healthcare providers to be able to recognize and manage psychological symptoms.
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* Coleman, C.N., Blumenthal, D.J., Casto, C.A. et al. (2013). Recovery and Resilience After a Nuclear Power Plant Disaster: A Medical Decision Model for Managing an Effective, Timely, and Balanced Response. (Abstract only.) Disaster Medicine and Public Health Preparedness. 7(2):136-45.
Based on experience from the Fukushima Daiichi nuclear power plant crisis, the authors propose a real-time medical decision-making model to ensure timely, organized, and effective response following a radiological or nuclear disaster. This model is in line with the current National Response Framework, and the authors suggest that it be used to manage "complex, large-scale, and large-consequence incidents."
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Dodgen, D., Norwood, A., Becker, S., et al. (2017). Social, Psychological and Behavioral Responses to a Nuclear Detonation in a US City: Implications for Healthcare Planning and Delivery. Disaster Medicine and Public Health Preparedness. 5(Suppl. 1).
The authors reviewed literature on human responses to radiation incidents and disasters in general, with a focus on behavioral health care provider (BHCP) contributions in the hours and days after a nuclear detonation. They listed the following six broad categories of interventions: promoting appropriate protective actions, discouraging dangerous behaviors, managing patient/survivor flow to facilitate the best use of scarce resources, supporting first responders, assisting with triage, and delivering palliative care when appropriate. The authors also shared recommendations regarding response and recovery phase BHCP interventions.
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Chapter 5 of this report covers the “Remediation Strategy Implementation,” including hard surface and building decontamination techniques and guidelines, food and agricultural safety, and forest and aquatic area remediation. A chapter on waste management with guidelines on storing contaminated materials follows.
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International Atomic Energy Agency. (2021). Emergency Preparedness and Response.
This webpage provides links to resources on real-world responses to radiological and/or nuclear accidents.
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International Commission on Radiological Protection. (2018). Medical and Health Surveillance in Post-Accident Recovery: Experience After Fukushima.
This is a review of the Nuclear Emergency Situations – Improvement of Medical and Health Surveillance (SHAMISEN) report on long-term lessons learned from the Fukishima accident using health management survey data. The paper briefly outlines recommendations for improving future health surveillance efforts to monitor affected populations for secondary adverse health events and social issues resulting from a radiological incident.
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This report includes follow-up healthcare-specific recommendations for select populations in affected areas and suggestions for future research. Environmental monitoring and remediation suggestions are also provided, followed by recommendations for economic and social policy.
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Lochard, J. and Prêtre, S. (1995). Return to Normality after a Radiological Emergency. Health Physics. 68(1): 21–26.
While dated, the information in this article is focused on helping communities understand how to determine post-incident acceptability (or “return to normal”). The various components covered by the authors include time post-incident, the zoning process (including the negative effects of establishing zones), and the “reference to the norm.”
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Morimura, N., Asari, Y., Yamaguchi, Y., et al. (2013). Emergency/Disaster Medical Support in the Restoration Project for the Fukushima Nuclear Power Plant Accident. Emergency Medical Journal. 30: 997-1002.
The authors describe the medical response to the incident, including patient decontamination. Photos of the decontamination tent and tables illustrating diagnosis and patient outcome are included.
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This announcement from the National Nuclear Security Administration discusses a large radiological incident exercise conducted in Austin, Texas in 2022, known as Cobalt Magnet 22. The announcement discusses the participating Nuclear Emergency Support Team (NEST), which trains experts to inform decisionmakers during radiation emergencies.
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Elderly residents of care facilities evacuated after a disaster experienced a three-fold increase in mortality compared to baseline mortality in a control group. This potential impact should be considered in evacuation decision-making.
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Nuclear Emergency Situations Improvement of Medical and Health Surveillance (SHAMISEN). (2020). Recommendations and Procedures for Preparedness and Health Surveillance of Populations Affected by a Radiation Accident.
The SHAMISEN project report provides recommendations and lessons learned from analysis of the Chernobyl and Fukishima events. Guidance includes information on preparedness, early and intermediate response efforts, and long-term recovery needs.
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Rios, C.I., Cassatt, D.R., Hollingsworth, B.A., et al. (2021). Commonalities Between COVID-19 and Radiation Injury. Radiation Research. 195(1):1-24.
The authors highlight similarities in the clinical presentation of COVID-19 and acute radiation syndrome. Both conditions are accompanied by inflammation which can cause damage to multiple organ systems, disproportionately affecting those with underlying conditions. Past research on the biomarkers associated with radiation can be used to understand health effects associated with COVID-19 and can assist with developing treatments for both conditions.
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Tanisho, Y., Smith, A., Sodeoka, T., and Murakami, H. (2015). Post-Disaster Mental Health in Japan: Lessons and Challenges. Health and Global Policy Institute.
This report describes lessons learned from the Fukushima nuclear disaster in 2012. It includes recommendations for ensuring that psychosocial and mental health interventions consider the unique circumstances and cultural issues of a given disaster.
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General Guidance and Research


This guide was created to be a quick reference for those in the medical field during a radiation disaster. It provides summarized information for a plethora of scenarios, preparedness best practices, and guidelines for treatment, transport, and diagnoses of conditions associated with radiation exposure. This edition also includes information relevant to treatment of pediatric patients.
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This ASPR TRACIE document provides an overview of the potential health and medical response and recovery needs following a radiological or nuclear incident and outlines available resources for planners.
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This paper, written for and presented at the Vienna Convention of the United Nations, describes the humanitarian crisis that would occur following a nuclear weapon detonation. The author describes sustenance, healthcare, and other needs that need to be addressed in emergency plans.
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Centers for Disease Control and Prevention. (2020). Radiation Response Briefing Manual. United States Department of Health and Human Services.
This guide provides decisionmakers with information about types of radiation and radiological and nuclear incidents. It discusses which decisions need to be made, the roles of different agencies, relevant assets, measuring radiation doses, radioprotective medications, and assessing biological risk such as cancer risk.
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This document, written in conjunction with other major federal agencies, is a guide for emergency responders, federal, state, and local officials responding to a large-scale nuclear incident. It outlines best practices for communicating public health safety information and situational updates while coordinating response efforts.
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Federal Emergency Management Agency. (2020). Radiological Operations Support Specialist (ROSS). U.S. Department of Homeland Security.
This website describes the role of Radiological Operations Support Specialists (ROSS), a team of subject matter experts who provide critical information to decisionmakers in case of a radiological emergency. These experts are available to state, local, tribal, and territorial emergency managers to plan and respond to radiological emergencies.
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Federal Emergency Management Agency. (2022). Planning Guidance for Response to a Nuclear Detonation. Third Edition. Homeland Security Council Interagency Policy Coordination Subcommittee for Preparedness and Response to Radiological and Nuclear Threats.
This core resource document provides emergency planners (including emergency medical service planners, medical receiver planners, and mass care providers) recommendations specific to nuclear detonation incidents in an urban setting.
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This document lists five Missions and Tactics that should be carried out by first responders, emergency managers, and other response organizations just after a nuclear detonation in or near their jurisdiction. Each tactic is accompanied by a short checklist and annexes on radiation exposure detection, response, and triage are included.
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This document provides guidance based on a post-detonation timeline to help planners understand the general progression for select response and recovery activities (i.e., “early,” “intermediate,” and “late” protective action phases).
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This document can help emergency responders better understand patient needs after the detonation of an improvised nuclear device in an urban environment. It focuses on acute care hospitals, describing patient needs by zone (moderate damage, light damage, and beyond damage zone) and phase (planning, response and recovery).
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* Lawrence Livermore National Laboratory. (n.d.). Radiological and Nuclear Response Planning: Publications and References. (Accessed 6/15/2021.)
This webpage provides materials and resources related to nuclear or radiological incident medical planning and emergency preparedness guidance. It includes additional information on communications, protective actions, and responder roles and responsibilities. There are videos for reducing consequence and saving lives as well as infographics for preparedness planning initiatives.
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* National Academies of Sciences, Engineering, and Medicine. (2019). Exploring Medical and Public Health Preparedness for a Nuclear Incident: Proceedings of a Workshop.
Conference attendees from government and nongovernmental organizations, academia, and the private sector discussed the current status of medical and public health preparedness for a nuclear incident, examined how increasing concerns about the use of nuclear warfare could lead to potential changes in these assumptions, and discussed capacity building opportunities and challenges in the current threat environment. Chapter 8 discusses considerations for workforce capacity and willingness to respond.
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National Alliance for Radiation Readiness. (2021). Tools and Radiation Resources.
This webpage provides updated information on a range of nuclear and radiological incidence information. Information can be filtered by incident type, subtopics such as medical countermeasures and surveillance, as well as content type including planning templates, federal guidance, and exercise documentation.
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* Occupational Safety and Health Administration. (n.d.). Radiation Emergency Preparedness and Response. (Accessed 8/12/2021.)
This webpage is intended to help workers and employers who may be involved in emergency response operations or related activities during or following a radiation emergency, and employers and workers who may be impacted by radiation emergencies, but who do not have emergency response roles.
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* Radiation Emergency Medical Management. (2021). Nuclear Detonation: Weapons, Improvised Nuclear Devices.
This webpage provides a variety of information and resources for managing and responding to a nuclear detonation. Resources include general nuclear detonation information, a timeline of events, categories of medical effects, medical management protocol, sheltering in place guidance, and best practice for communications during a disaster.
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Radiation Emergency Medical Management. (2021). Video Library.
This webpage provides a comprehensive list of REMM general information videos related to radiological basics, dose estimation, contamination, and radiation emergencies.
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* Radiation Emergency Medical Management. (2021). What You Need to Know About Biodosimetry: The Basics.
This webpage summarizes general information on Biodosimetry compared to radiation bioassay, including its uses and value for long term surveillance.
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U.S. Environmental Protection Agency. (2018). Radiation Protection.
This website provides links to resources that can help protect communities from radiation (e.g., a dose calculator, basic information, protective actions, regulations, and response). A document library and links to related content are also provided.
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Washington State Department of Health. (n.d.). State Radiological Emergency Preparedness Agencies. (Accessed 6/15/2021.)
This webpage provides links to each U.S states specific radiological emergency preparedness agency or organization. This streamlined list provides a way to identify each state’s radiation public health page along with contract information and resources.
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Pediatric Considerations


American Academy of Pediatrics, Linet, M.S., Kazzi, Z., Paulson, J.A. (2018). Pediatric Considerations Before, During, and After Radiological or Nuclear Emergencies (Technical Report). 142(6).
This Technical Report is the companion document to the “Pediatric Considerations Before, During, and After Radiological or Nuclear Emergencies” Policy Statement issued by the American Academy of Pediatrics in 2018. It discusses acute radiation syndrome, acute and long-term psychological effects, cancer risks, and other late tissue reactions after low-to-high levels of radiation exposure, as well as measures to reduce radiation exposure in the immediate aftermath of a radiologic or nuclear disaster.
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This guide was created to be a quick reference for those in the medical field during a radiation disaster. It provides summarized information for a plethora of scenarios, preparedness best practices, and guidelines for treatment, transport, and diagnoses of conditions associated with radiation exposure. This edition also includes information relevant to treatment of pediatric patients.
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* Crouch, G., Schor, K., and Fitzgerald, T. (2013). Radiation Issues in Children: Knowledge Check, Primer, & Case-Based Activity. National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences.
This webpage provides links to a knowledge check, primer, and case studies on radiation issues in children.
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Gardner, A.H., Dziuban, E.J., Griese, S., et al. (2018). Medical Countermeasures for Children in Radiation and Nuclear Disasters: Current Capabilities and Key Gaps. (Abstract only.) Disaster Medicine and Public Health Preparedness.
The authors conducted a literature review and gap analysis related to pediatric medical countermeasures. They identified 15 gaps in information needed to support the safe and successful use of MCMs in children during radiation emergencies, and prioritized them based upon the potential to decrease morbidity and mortality, improve clinical management, strengthen caregiver education, and increase the relevant evidence base.
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* Radiation Emergency Medical Management. (2019). Prototype/Template for Adult and Pediatric Hospital Orders During a Radiation Incident. U.S. Department of Health and Human Services.
These orders--while meant to serve solely as guidance documents--can be tailored and used by healthcare providers who treat adult and pediatric patients after a radiological incident. Helpful links are included throughout the prototypes.
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WRAP-EM hosted this workshop to provide pediatric-specific information for healthcare coalitions to include in their radiation surge annexes. Information is provided in three modules: Pediatric Considerations after a Dirty Bomb, Medical Countermeasures, and Additional Resources
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Yonekura, T., Ueno, S., and Iwanaka, T. (2013). Care of Children in a Natural Disaster: Lessons Learned from the Great East Japan Earthquake and Tsunami. (Abstract only.) Pediatric Surgery International. 29(10): 1047-1051.
The authors incorporate lessons learned from the Fukushima disaster into response recommendations for pediatric surgeons and physicians.
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Plans, Tools, and Templates


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Agency for Toxic Substances and Disease Registry. (2020). Epi CASE (Contact Assessment Symptom Exposure) Toolkit.
This tool, modeled after the Rapid Response Registry Toolkit, assists public and medical health professionals assess exposure to nuclear or radiological agents after an emergency incident. The data collected can be used to inform epidemiologic need.
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The 2019-2023 HPP Funding Opportunity Announcement (FOA) requires healthcare coalitions (HCCs) to develop a complementary coalition-level radiation emergency surge annex to their base medical surge/trauma mass casualty response plan. This annex aims to improve capacity and capabilities to manage exposed or potentially exposed patients during a radiation emergency.
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California Emergency Medical Services Authority. (2014). Hospital Incident Command System (HICS) 2014: Incident Response Guides.
Hospital planners can use these guides to help ensure a safe environment for patients, staff, and visitors within hospitals following certain incidents (e.g., radiation, chemical). Access the 2006 nuclear and radiological attack scenarios here: https://emsa.ca.gov/hospital-incident-command-system-external-scenarios/
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Centers for Disease Control and Prevention. (n.d.). SimPLER. (Accessed 8/10/2022) United States Department of Health and Human Services.
Emergency managers can use the Simulation Program for Leveraging and Evaluating Resources, or SimPLER, to simulate planning bottlenecks, staffing, and throughput capacity to plan for many kinds of emergencies. Based on data from emergency exercises around the country, SimPLER includes modules on community reception centers and points of dispensing.
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Centers for Disease Control and Prevention. (2013). Radiological Terrorism: Tool Kit for Emergency Services Clinicians.
This toolkit contains resources (such as videos and pocket guides) on decontamination, population monitoring, and psychological first aid in radiation emergencies.
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Centers for Disease Control and Prevention. (2014). Internal Contamination Clinical Reference (ICCR) Application.
The Internal Contamination Clinical Reference is an application (for Android devices, iPads, and iPhones) estimating reference concentrations of radionuclides in urine assuming intakes equal to one Clinical Decision Guide (CDG) for each radionuclide.
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This webpage includes a series of handbooks for portable meters that may be used in the field to detect internal radiation contamination, as well as instructions for using Gamma cameras to assess internal contamination.
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This tool offers summaries, action steps, and checklists for the following ten topics for inclusion in community reception center plans: (1) lead agency and public health role, (2) registry and surveillance, (3) communications, (4) CRC sites, (5) stations, (6) staffing and training, (7) equipment and supplies, (8) demobilization, (9) behavioral health, and (10) access and functional needs. It is intended to be used with jurisdictional point of distribution plans, "Population Monitoring in Radiation Emergencies," and the resources listed with each checklist.
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Centers for Disease Control and Prevention. (2018). Radiological Terrorism: Emergency Management Pocket Guide for Clinicians.
This webpage provides links and information related to the CDC pocket guide for "Radiological Terrorism: Just in Time Training for Hospital Clinicians." The guide can help healthcare professionals who provide emergency care in a hospital setting following a radiological terrorism incident.
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This webpage provides information related to assessing and monitoring population exposure during a radiological incident. Included are guidance and planning tools, resource guides, and toolkits for operating community reception centers.
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Centers for Disease Control and Prevention, Emergency Preparedness and Response. (2014). Community Reception Center (CRC) Simulation Tools.
The Centers for Disease Control and Prevention developed two simulation programs (CRC-STEP and RealOpt-CRC) that can help emergency healthcare providers test their Community Reception Center (CRC) models. The programs can help users: analyze CRC throughput; identify bottlenecks; and highlight the need for additional resources.
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Centers for Disease Control and Prevention, Emergency Preparedness and Response. (2014). Radioactive Isotopes.
This webpage hosts links to information by isotope (e.g., cesium, iodine, plutonium). Users can click on the link to learn about each isotope's toxicity.
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* Centers for Disease Control and Prevention, Emergency Preparedness and Response. (2015). Virtual Community Reception Center (vCRC).
This web-based training tool teaches emergency healthcare planners how to conduct population monitoring after a mass casualty radiation emergency in community reception centers.
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* Coleman, C.N., Blumenthal, D.J., Casto, C.A. et al. (2013). Recovery and Resilience After a Nuclear Power Plant Disaster: A Medical Decision Model for Managing an Effective, Timely, and Balanced Response. (Abstract only.) Disaster Medicine and Public Health Preparedness. 7(2):136-45.
Based on experience from the Fukushima Daiichi nuclear power plant crisis, the authors propose a real-time medical decision-making model to ensure timely, organized, and effective response following a radiological or nuclear disaster. This model is in line with the current National Response Framework, and the authors suggest that it be used to manage "complex, large-scale, and large-consequence incidents."
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This handbook and pocket card (which may be ordered on-line) provide a training and reference tool for first responders with various degrees of radiological experience to respond to a radiological event.
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* Conference of Radiation Control Program Directors, Inc. (n.d.). Radiation Response Volunteer Corps Development ToolKit. (Accessed 8/16/2021.)
This website includes a “Templates and Forms” tab. Helpful templates include; Kansas Community Center Flow Diagram; Kansas Radiation Incident Community Reception Center Standard Operating Guidelines; Kansas Department of Health and Environment CRC Template; and Union County (OH) Example CRC Supply and Equipment List.
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This document, written in conjunction with other major federal agencies, is a guide for emergency responders, federal, state, and local officials responding to a large-scale nuclear incident. It outlines best practices for communicating public health safety information and situational updates while coordinating response efforts.
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This interactive map displays U.S Nuclear Power Plant (NPP) data gathered from the Nuclear Regulatory Commission (NRC) and Department of Energy (DOE) Energy Information Administration. It combines other useful emergency preparedness data such as Environmental Protection Agency (EPA) radiation air monitor locations.
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Federal Emergency Management Agency and U.S. Department of Homeland Security. (2023). Obtaining Models and Simulations for Radiological/Nuclear Trainings and Exercises Summary.
These three tools provide emergency managers, first responders, and exercise coordinators the ability to access plume models and interactive simulations for exercises, trainings, and emergency planning activities.
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Flood, A.B., Boyle, H.K., Du, G., et al. (2014). Advances in a Framework to Compare Bio-dosimetry Methods for Triage in Large-Scale Radiation Events. Radiation Protection Dosimetry. 159(1-4):77-86.
The authors compared the performance of six bio-dosimetry methods for five different population sizes ranging from 100-1,000,000, at a rate of 15 or 15,000 people per hour with four additional time windows. They conclude that larger population sizes require longer triage times, which decreases the usefulness of time-intensive methods. They discuss the value of using multiple methods to assess casualties.
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Hick, J., Bader, J., Coleman, N., et al. (2017). Proposed “Exposure And Symptom Triage” (EAST) Tool to Assess Radiation Exposure After a Nuclear Detonation. (Abstract only.) Disaster Medicine and Public Health Preparedness. (12)3: 1-10.
The authors share results from the work of an interdisciplinary working group composed of federal, state, and local public health experts who developed the Exposure And Symptom Triage (EAST) tool. This tool combines estimates of exposure from maps with clinical assessments and single lymphocyte counts (if available) to help emergency healthcare providers triage patients after a nuclear incident.
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Koerner J.F., Coleman, C.N., Murrain-Hill, P. et al. (2014). The Medical Decision Model and Decision Maker Tools for Management of Radiological and Nuclear Incidents. (Abstract only.) Health Physics. 106(6):645-51.
During or after a radiological or nuclear disaster, onsite subject matter experts may not be immediately available, yet critical decisions for a complex response must be made. The authors describe a model to assist decision makers and describe tools to facilitate timely and effective incident management.
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* Lawrence Livermore National Laboratory. (n.d.). Radiological and Nuclear Response Planning: Publications and References. (Accessed 6/15/2021.)
This webpage provides materials and resources related to nuclear or radiological incident medical planning and emergency preparedness guidance. It includes additional information on communications, protective actions, and responder roles and responsibilities. There are videos for reducing consequence and saving lives as well as infographics for preparedness planning initiatives.
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This "consensus guidance document" can be used by ambulance services owners/operators to prepare for, respond to, and recover from, a radiological incident. It includes sample placards, a list of acronyms and abbreviations, and other resources that can be tailored by others.
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The author synthesized expert opinion on the feasibility of developing self-sustaining volunteer emergency response programs to perform tasks associated with radiation emergencies (e.g., population monitoring) and help in other ways at hospitals, community reception areas, and other areas.
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Meit, M., Redlener, I., Briggs, T., et al. (2011). Rural and Suburban Population Surge Following Detonation of Improvised Nuclear Device: A New Model to Estimate Impact. Disaster Medicine and Public Health Preparedness. 5. Supplement 1.
The authors describe a “push-pull” model that estimated the evacuation from Manhattan to counties within a 150 mile radius after a nuclear detonation. This model predicted that arriving evacuees could increase the population needing services by between 50 and 150 percent.
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* National Academies of Sciences, Engineering, and Medicine. (2019). Exploring Medical and Public Health Preparedness for a Nuclear Incident: Proceedings of a Workshop.
Conference attendees from government and nongovernmental organizations, academia, and the private sector discussed the current status of medical and public health preparedness for a nuclear incident, examined how increasing concerns about the use of nuclear warfare could lead to potential changes in these assumptions, and discussed capacity building opportunities and challenges in the current threat environment. Chapter 8 discusses considerations for workforce capacity and willingness to respond.
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National Association of County and City Health Officials. (2018). Radiation Toolkit: Resources to Help You Prepare for a Radiation Emergency.
This toolkit provides planning information for state and local public health officials to address specific needs of their jurisdiction during a radiological incident. Guidance includes information on supporting mass care and radiation sheltering; radiation response volunteer resources; and risk communication and public communication.
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* National Center for Environmental Health: Radiation Studies Branch. (2011). Detonation of an Improvised Nuclear Device.
This social media message planning resource summarizes the findings of the Nuclear Detonation Response Communications Working Group during their analysis of messaging and communication in the aftermath of a nuclear incident. In their study, six 90-minute focus groups analyzed an array of different messaging examples for relevance, comprehensibility, and credibility. Results gathered highlight the effectiveness of the messaging and provide useful lessons learned and best practices for future communications initiatives.
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NYC Hospital Radiation Response Working Group, NYC Department of Health and Mental Hygiene, Healthcare Emergency Preparedness Program. (2009). NYC Hospital Guidance for Responding to a Contaminating Radiation Incident.
This guidance was prepared to help New York City Hospitals prepare their response to an emergency involving radioactive contamination. The guidance and strategies can be tailored to other city hospitals.
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Oak Ridge Institute for Science and Education. (2021). Radiation Emergency Assistance Center/Training Site.
This webpage links to the Radiation Emergency Assistance Center/Training Site (REAC/TS), which offers several resources to prepare medical professionals to respond to radiological emergencies. There are links to books, live training courses, online trainings, and assessment and treatment guidance documents. REAC/TS staff are available for deployment to provide medical consultation during emergencies, upon request.
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* Occupational Safety and Health Administration. (n.d.). Radiation Emergency Preparedness and Response. (Accessed 8/12/2021.)
This webpage is intended to help workers and employers who may be involved in emergency response operations or related activities during or following a radiation emergency, and employers and workers who may be impacted by radiation emergencies, but who do not have emergency response roles.
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These handbooks cover the radiation incident recovery process for food production, inhabited areas, and drinking water.
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Radiation Emergency Medical Management. (2018). Planners: Preparedness and Response.
This webpage includes links to resources that can help emergency planners establish procedures for before, during, and after a radiological or nuclear event.
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Radiation Emergency Medical Management. (2018). Triage Category and Cytokine (G-CSF) Use after a Nuclear Detonation.
Healthcare providers can use this triage tool in the event of a radiation emergency. While it does not use standard triage categories, providers can classify patients as "Radiation only," "Combined injury (radiation and trauma and/or burn)"; or "Trauma or burn only." Links to the offline tool and triage tool cards are also provided on this page.
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* Radiation Emergency Medical Management. (2019). Prototype/Template for Adult and Pediatric Hospital Orders During a Radiation Incident. U.S. Department of Health and Human Services.
These orders--while meant to serve solely as guidance documents--can be tailored and used by healthcare providers who treat adult and pediatric patients after a radiological incident. Helpful links are included throughout the prototypes.
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* Radiation Emergency Medical Management. (2021). Nuclear Detonation: Weapons, Improvised Nuclear Devices.
This webpage provides a variety of information and resources for managing and responding to a nuclear detonation. Resources include general nuclear detonation information, a timeline of events, categories of medical effects, medical management protocol, sheltering in place guidance, and best practice for communications during a disaster.
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* Radiation Injury Treatment Network. (2021). Exercises.
This webpage provides multiple hospital preparedness exercises for a nuclear or radiological emergency and including all materials necessary to conduct full-scale, functional and tabletop exercises.
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Radiation Injury Treatment Network. (2021). Resources.
This webpage includes a list of planning guides and templates for response to a nuclear or radiological incident.
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This checklist provides information to diminish loss of lives following a nuclear detonation. This tool should be used as a preparedness tool and during the planning process.
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Sullivan, J.M., Prasanna, P.G., Grace, M.B., et al. (2013). Assessment of Biodosimetry Methods for a Mass-Casualty Radiological Incident: Medical Response and Management Considerations. Health Physics. 105(6):540-54.
The authors provide an extensive review of biodosimetry methods and their respective utility following a mass casualty radiological incident, taking into account disruptions in infrastructure, limited resources, ease of use, and time to results. They conclude that no single method will be sufficient, and that biodosimetry is one component of what must be a more comprehensive approach to triage and medical management of casualties.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2012). Medical Planning and Response Manual for a Nuclear Detonation Incident: A Practical Response Guide.
This comprehensive document provides emergency planners with information not only on the effects of radiation and how to measure and treat them, but also on how to communicate during a radiological or nuclear emergency. It also describes federal response roles and the distribution of medical countermeasures for acute radiation sickness in an environment of scarce resources.
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U.S. Department of Health and Human Services, Radiation and Emergency Medical Management. (2014). Develop a Radiation Response Plan.
This webpage provides links to guidance on developing a community hospital response plan, developing a hospital response team, and general information that should be considered when planning for a nuclear detonation or similar event.
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This guidance can help preserve responder health and safety in the event of a 10 kiloton improvised nuclear device within the first 72 hours of a detonation and is one of the few sources of information for advice about scene hazard control /mitigation and environmental considerations.
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This planning tool consists of a base document and three corresponding incident-specific planning documents. The base document covers general guidance applicable to all radiological and nuclear incidents, and the other documents provide guidance for suspected or deliberate attacks, inadvertent incidents, and international incidents. This annex can be used by federal, state, local, and voluntary organizations to enhance planning efforts and ensure coordination with federal planning efforts.
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This planning document provides guidance to first responders and local response agencies in understanding the critical missions and tasks that should be undertaken within the first 100 minutes of a radiological dispersal device denotation response. Public messaging, response coordination, personal protective equipment, and equipment resource recommendations are reviewed within the document. The authors also include customizable planning tools and worksheets.
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This manual can help public officials plan for emergency response to radiological incidents. The manual consists of two overarching response areas: protective action guides, and protective actions which are further broken down into early, intermediate, and late phase response actions for radiological incidents. Each phase describes corresponding response actions (e.g., evacuation, sheltering in place, administration of medication, worker protection, and clean up, and disposal of radiological waste).
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* Various Authors. (2011). Disaster Medicine and Public Health Preparedness. Volume 5. Supplement 1.
This special issue contains articles highlighting the work of the Nuclear Detonation Scarce Resources Project Working Group. Included are discussions of triage and medical management of casualties resulting from nuclear detonations; social and behavioral response considerations for planners; and guidance to support health care system preparedness to respond to a nuclear detonation.
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Population Monitoring/Community Reception Centers


This document was created as guide by the Department of Homeland Security, FEMA division to provide technical guidance for regional, state, and local responders charged with developing nuclear detonation response plans for their jurisdictions. The guide outlines critical fallout information, external and internal exposure protocol, a timeline of response activities, and considerations for population monitoring and contamination detection methods.
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Centers for Disease Control and Prevention. (n.d.). Community Reception Center Flow Diagram. (Accessed 2/3/2020.)
This is a set of floorplans for various stages of Community Reception Centers, including intake, emergency medical care or transfer, and discharge.
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This guide provides information for state and local planners to develop post radiological emergency response plans. This guide describes processes for managing the radiation monitoring required to evaluate exposure in the affected population, including the use of community reception centers.
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Centers for Disease Control and Prevention. (2015). Community Reception Center (CRC) Drill Toolkit.
The CRC Drill toolkit provides guidance and templates that any jurisdiction can adapt to exercise the full range of CRC operations. The drill was developed to be compatible with the U.S. Department of Homeland Security’s Homeland Security Exercise and Evaluation Program (HSEEP). It also incorporates insights, issues, and lessons learned from real-world events.
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This webpage provides information related to assessing and monitoring population exposure during a radiological incident. Included are guidance and planning tools, resource guides, and toolkits for operating community reception centers.
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* Conference of Radiation Control Program Directors, Inc. (n.d.). Radiation Response Volunteer Corps Development ToolKit. (Accessed 8/16/2021.)
This website includes a “Templates and Forms” tab. Helpful templates include; Kansas Community Center Flow Diagram; Kansas Radiation Incident Community Reception Center Standard Operating Guidelines; Kansas Department of Health and Environment CRC Template; and Union County (OH) Example CRC Supply and Equipment List.
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Florida Department of Health. (2011). After-Action Report and Improvement Plan Matrix.
This report covers the July 12, 2011, Community Reception Center (CRC) Drill conducted at Cypress Creek High School in Orlando, Florida. The Improvement Plan highlights recommendations and adjudications to the state CRC plan. Appendices are included.
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This discussion paper describes the screening function (Exposure And Symptom Triage – EAST) which will primarily be conducted at Assembly Centers after a nuclear detonation. Geared towards jurisdictional emergency planners and responders as a planning reference, it contains response tools and strategies that will assist them in planning for Assembly Centers and mass screening functions.
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This document provides steps for responders to take upon receipt of residents at Community Reception Centers. It includes forms for responders and handouts for visitors.
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This master’s thesis includes a detailed literature review of published and gray literature on the effectiveness of community reception centers for managing population evaluation.
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Resources for Emergency Responders


This document lists five Missions and Tactics that should be carried out by first responders, emergency managers, and other response organizations just after a nuclear detonation in or near their jurisdiction. Each tactic is accompanied by a short checklist and annexes on radiation exposure detection, response, and triage are included.
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* Institute for Disaster Mental Health at SUNY New Paltz. (n.d.). Disaster Mental Health: Assisting People Exposed to Radiation. (Accessed 6/15/2021.)
This document was developed for the New York State Department of Health to address mental health needs of first responders and victims exposed to radiation. The training guide provides information related to identifying psychosocial issues, maintaining the mental health of emergency response personnel, and understanding self-care and intervention practices. Access the related presentation: https://portal.ct.gov/-/media/DMHAS/Publications/DMHRadiationXposurepdf.pdf.
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National Institute for Occupational Health and Safety. (2018). Chemical, Biological, Radiological, and Nuclear (CBRN) Respiratory Protection Handbook. Atlanta, GA: The Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Response.
This document provides technical information on use of NIOSH respiratory protective devices (RPD) during a nuclear or radiological emergency. Guidance includes information on respiratory program requirements, fit testing methods, and user training.
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Radiation Emergency Medical Management. (2018). Initial On-site Activities.
The resources linked from this webpage can help first responders manage the scene and victims of a radiological incident.
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Radiation Emergency Medical Management. (2018). Transport Victims of Radiation Emergencies.
This webpage contains links to resources geared towards teaching responders how to transport victims contaminated in a radiological incident.
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Radiation Emergency Medical Management. (2018). Triage Guidelines Including Radiation Triage Guidelines.
This webpage provides links to radiation-related triage tools, guidelines, and algorithms.
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Radiation Emergency Medical Management. (2019). First Responders in the Field.
This webpage includes links to helpful resources for responders on radiation-specific personal protective equipment, incident response (including casualty management and triage), and online training courses.
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Radiation Emergency Medical Management. (2021). First Responders: Information for Radiation Emergencies.
This webpage includes information on personal protective equipment, protective action guides, and triage in the field. It also includes additional reference material from other agencies and organizations.
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* Radiation Emergency Medical Management. (2021). What You Need to Know About Biodosimetry: The Basics.
This webpage summarizes general information on Biodosimetry compared to radiation bioassay, including its uses and value for long term surveillance.
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This planning document provides guidance to first responders and local response agencies in understanding the critical missions and tasks that should be undertaken within the first 100 minutes of a radiological dispersal device denotation response. Public messaging, response coordination, personal protective equipment, and equipment resource recommendations are reviewed within the document. The authors also include customizable planning tools and worksheets.
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Scarce Resources


Casagrande, R., Wills, N., Kramer, E., et al. (2011). Using the Model of Resource and Time-Based Triage (MORTT) to Guide Scarce Resource Allocation in the Aftermath of a Nuclear Detonation. Disaster Medicine and Public Health Preparedness. Volume 5. Supplement 1.
The authors used the model of resource- and time-based triage (MORTT) and found that in settings where resources were scarce, prioritizing victims with moderate life-threatening injuries over victims with severe life-threatening injuries saves more lives and reduces demand for intensive care.
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Coleman, C.N., Knebel, A. R., Hick, J.L. et al. (2011). Scarce Resources for Nuclear Detonation: Project Overview and Challenges. Disaster Medicine and Public Health Preparedness. Volume 5. Supplement 1.
This article summarizes the medical challenges associated with scarce resources and nuclear detonations, and serves as an introduction to the rest of the articles in this issue.
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Coleman, C.N., Weinstock, D.M., Casagrande, R. et al. (2011). Triage and Treatment Tools for Use in a Scarce Resources-Crisis Standards of Care Setting After a Nuclear Detonation. Disaster Medicine and Public Health Preparedness. Volume 5. Supplement 1.
Based on the information shared in other articles in this issue, the authors discuss possible triage options during the first four days after an event.
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DiCarlo, A.L., Maher, C., Hick, J.L. et al. (2011). Radiation Injury After a Nuclear Detonation: Medical Consequences and the Need for Scarce Resources Allocation. Disaster Medicine and Public Health Preparedness. Volume 5. Supplement 1.
This literature review focuses on radiation injuries from human exposures and animal models and is accompanied by various triage and management approaches (covered in the rest of this special issue).
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Hick, J.L., Weinstock, D.M., Coleman, C.N. et al. (2011). Health Care System Planning for and Response to a Nuclear Detonation. Disaster Medicine and Public Health Preparedness. Volume 5. Supplement 1.
The authors use vignettes to describe how a nuclear the incident may unfold for the various components of the health and medical systems. They also emphasize the need for first responders to protect themselves physically and psychologically.
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Knebel, A.R., Coleman, C.N., Cliffer, K.D. et al. (2011). Allocation of Scarce Resources After a Nuclear Detonation: Setting the Context. Disaster Medicine and Public Health Preparedness. Volume 5. Supplement 1.
The authors emphasize the need for all involved sectors to plan and practice for the allocation of scarce resources in a nuclear incident.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2012). Medical Planning and Response Manual for a Nuclear Detonation Incident: A Practical Response Guide.
This comprehensive document provides emergency planners with information not only on the effects of radiation and how to measure and treat them, but also on how to communicate during a radiological or nuclear emergency. It also describes federal response roles and the distribution of medical countermeasures for acute radiation sickness in an environment of scarce resources.
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U.S. Department of Health and Human Services, Radiation Emergency Medical Management. (2021). Nuclear Detonation Scarce Resources Project Working Group Publications.
This link takes users to the full triage module on REMM. This provides users access to an online flowchart/decision tree for complex triage decisions and links to various resources which provide the background information on triaging and medically managing patients in the early days following a radiological event. The online Triage tool allows for data entry and customization of decision-making.
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Agencies and Organizations


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American College of Radiology. Disaster Preparedness and Response.
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Biomedical Advanced Research and Development Authority. Chemical, Biological, Radiological, And Nuclear (CBRN) Medical Countermeasures. U.S. Department of Health and Human Services.
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Centers for Disease Control and Prevention. Radiation Emergencies.
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Federal Emergency Management Agency. Radiological Operations Support Specialist (ROSS). Department of Homeland Security.
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Federal Emergency Management Agency. Radiological Emergency Preparedness.
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International Atomic Energy Agency. Emergency Preparedness and Response.
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International Commission on Radiological Protection. ICRP Publications.
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National Alliance for Radiation Readiness. RadiationReady.Org.
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Oak Ridge Institute for Science and Education. Radiation Emergency Assistance Center/Training Site.
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U.S Department of Energy, National Nuclear Security Administration. Nuclear Incident Response.
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U.S. Department of Health and Human Services. Radiation Emergency Medical Management.
Resources are placed into the following sections:
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