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U.S. Department of Health and Human Services

Action Steps: Phase 3

State and Local Planners Playbook For Medical Response to a Nuclear Detonation


Phase III: Beyond 96 hours post-detonation
IN ADDITION to what has been started on Day 1-4

Line number


Information Source


General Readiness Planning and Emergency Management


Local, state, and federal officials continue to assess the situation and define the damage and fallout zones and prioritize access and service restoration

IS #2


Law enforcement defines perimeters and continues to manage traffic flow
Increased number of people will return to area. Security required.



Donations management and management of unsolicited volunteers and ‘disaster tourists’ as well as media becomes a focus



Resupply, clean-up, and restoration of utilities anticipating major return of population.



Frequent communication with the public in a coordinated manner via the JPIC continues, including communication of risks of residual contamination and hazards of clean-up



Continue transfer of victims who may need delayed medical care to National Disaster Medical System (NDMS), RITN and other jurisdictions.

IS #15


Prioritize service restoration for major hospitals and healthcare facilities as possible



Begin disposition planning for special needs shelter patients and the medically fragile, slow demobilization of shelters over time



Debris removal with heavy equipment continues in support of rescue operations in the Moderate Damage zone for the first 7-10 days



As perimeters become better established, create screening and decontamination corridors for vehicles



Create guidance for transport and disposal of contaminated items (including contaminated medical waste) in conjunction with Federal experts



Emergency Medical Services


Reallocate resources as last of the victims from Moderate Damage zone rescued, recovery operations commence in Severe Damage zone. Pressure on EMS systems continues due to ongoing patients with complications of ARS and difficulty responding in timely manner due to service area disruptions/access issues



RTR sites demobilized. Some RTR-3 sites may function as assembly centers.



Support care at assembly centers / shelters. Continue transporting victims to evacuation locations, which will decrease after first 10 days. Transport displaced persons with chronic illnesses to appropriate medical or special needs shelter facilities.



Healthcare Facility Response


Continually reassess survivors as scarce resource situation improves. Most will have ended crisis standards of care.
Anticipate many “concerned citizens” reaching facility requiring proper sorting from continued large numbers with ARS symptoms

IS #8


Continue to screen and help monitor victims with ALC as well as obtaining laboratory results for clinical/epidemiologic data



Continue to request necessary supplies / staff from HMCC or EOC as directed



Provide support as possible to MC-Medical Care facilities, including alternate care facilities, and AC- Assembly Centers, to where people without immediate medical needs will be directed. Slow demobilization of these facilities over time

IS #3


Finish transfer of victims to NDMS, RITN, burn and other specialty care facilities

IS #15


Continue to modify services provided to focus on ability to provide emergency and acute care, slow resumption of usual hospital services. Daily planning cycles and incident action planning continue



Public Health


Consider returning people to habitable zone in conjunction with Federal and state guidance

IS #2


Continue patient and victim tracking

IS #6


Continue reunification hotline.

IS #10


Provide instructions for public as to where to resume care for pre-incident illnesses including provision of dialysis



Continue to implement and expand operations of mass fatality plan including integration of Federal DMORT teams as recovery becomes focus after rescue phase concludes (when moderate zone searched)

IS #12


Scale up transfer of victims and potential victims of acute radiation syndrome to RITN centers and their communities for observation and management over next few weeks.

IS #15


Medical System Response



HMCC must maintain situational awareness, including daily incident action plans and communication with member hospitals and liaison with key stakeholders at EOC



Monitor healthcare system demand and balance loads across local and regional hospitals as possible by allocating available staff and resources to those areas with greatest need and prioritizing evacuation of patients from most-stressed facilities



Facilitate evacuation of facilities that have structural damage but were unable to evacuate earlier



Facilitate request and delivery of resources including personnel, SNS assets



Determine, with public health, transition of myeloid cytokines administration from AC/MC sites to clinics and other locations to continue daily treatment and contact with at-risk group 2-6Gy that was not able to be evacuated



Continually reassess standards of care in area and provide talking points to JPIC about when/where to seek care. Slow transition to normalization of medical care provision

IS #6


Evacuee Medical Care and Fallout-related Radiation Illness


Provide information as to who should and should not participate in long-term registry



Evacuate persons with likely 2-6Gy exposure to other jurisdictions for ongoing monitoring and myeloid cytokines treatment



Provide instructions and daily myeloid cytokines to the 2-6Gy exposure group that remains in the area and assure that similar clinics/centers are set up in neighboring jurisdictions (may start at AC and MC and transition to monitoring clinics set up according to jurisdictional plan with PH/EM)



Continue to triage patients for evacuation based on epidemiologic information and symptoms with addition of ALC as blood tests become more widely available





Use ever-improving radiation and plume modeling and data to guide plans for recovery. Convene local groups along with outside radiation experts. Can define areas that will have NO radiation and remain useable and those with minimal risk.



Provide more detailed information about decontamination of property and vehicles to population



Provide easily understood information about relative risk for future malignancies and impact on property to those in fallout areas



Emphasize community resilience and neighbor helping neighbor.



Resume community functions, especially in unaffected areas



Increase staff and logistical support for long-term registry and for those to be followed for long-term cancer risk



Facilitate creation (with Federal agencies / VA system, others) of a network of integrated clinics that will follow and provide ongoing treatment for victims of the incident



Establish teams, timeline, and goals for medium- and long-term psychological support to help resilience.

IS #13

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  • This page last reviewed: February 14, 2012