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U.S. Department of Health and Human Services

Action Steps: Phase 2

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


Phase II: 24-96 hours post-detonation
IN ADDITION to what has been started on Day 1

Line number


Information Source


General Readiness Planning and Emergency Management


Maintain situational awareness and define the damage and fallout zones in collaboration with USG and other Federal partners

IS #2


Obtain situational awareness support from DHS and HHS. On-site measurements of radioactivity and prediction of levels for every 6 hours. Provide assessment of low level radiation in the down-wind fallout zones (not likely to require radiation injury treatment).



Utilize MedMap in coordination with HHS and DHS to assess medical assets

IS #4


Assign available law enforcement (and National Guard) to assist at transportation routes, staging areas, assembly centers and within damage zones for property protection.



Have JPIC provide frequent communication with the public in a coordinated manner with Federal messages



Prepare for air-based transfer of victims to other jurisdictions, NDMS hospitals, RITN and Veterans Administration hospitals. This will include those in the latent phase of radiation illness who can fly via commercial charter. Assist Federal and state counterparts in arranging logistics to airport.



Define acceptable level of superficial contamination on vehicle and individuals for transportation outside affected area with Federal partners.



Other jurisdictions in region open assessment centers and shelters for evacuees to include medical screening and assessment for radiation illness and contamination



Prepare to support arriving military and civilian assets and assure common operating picture / communications plan and define operating periods and briefings



Track requested and unrequested arriving assets, emphasize staging area use and request logistical support for assets as needed



Define priorities for utilities, street clearing, and essential service restoration to Light Damage zone



Emergency Medical Services (EMS)


Anticipate that victim mixture to begin to change- more radiation victims reaching medical care and trauma victims with radiation from Moderate Damage and Severe Damage zone search and rescue and trauma/burn victims without radiation from Light Damage zones and vehicle collisions.

IS #2


Anticipate that triage, treatment, transportation of acutely wounded - RTR-1, -2 largely no longer needed, and RTR -3 transported to Medical Care (MC) center or AC.

IS #3


Support Urban Search and Rescue and fire crews as they define / grid search zones and begin more systematic searches of moderate damage areas.



Support care at assembly centers / shelters, support continued emergency response demand. Mutual aid resources support patient evacuation.
Assist in administration of palliative care.



Receive and disseminate to crews any triage criteria for myeloid cytokines treatment or medical referral and the locations of the AC and MC sites.



Continue to utilize non-traditional transport, batched transport of patients, and other contingency mechanisms



Request supplemental staff and resources via EOC including supplies



PSAPs continue to triage calls/responses – update criteria as needed in conjunction with PH and healthcare system



Healthcare Facility Response


Reassess survivors as scarce resource setting changes.
Anticipate many “concerned citizens” reaching facility requiring ongoing assessment and triage – many symptoms of anxiety overlap with early ARS.

IS #8


Assess critical medical supplies and work to balance supply and demand.
Work with ICS to receive supplies from SNS including myeloid cytokines.



Obtain ALCs and track symptoms of patients over time to obtain more specific prognosis – provide myeloid cytokines to those who will receive aggressive care (see priority table IS #3)

IS #15


Work with HMCC to determine status of system, including alternate care facilities, and AC, to where people without immediate medical needs will be directed.

IS #3


Discharge and/or transfer appropriate in-patient population to free up beds and resources for the influx of victims in conjunction with EMS. Provide patient lists for transfer to HMCC



Contain radiologic contamination within facility if present and provide more screening of individuals presenting to facility with at least dry and perhaps wet decontamination



Use REMM for assessment and treatment guidelines for ARS

IS #11


Request additional personnel/staff as needed from HMCC



Public Health


Continue evacuation of Dangerous Fallout areas. With EM, develop and publicize maps illustrating contaminated areas and the level of risk within those areas in the hours after the blast.

IS #2


Provide messaging about who should NOT go to a medical facility, in order to allow resources to be used for seriously injured and who should go to an Assembly Center or Medical Care center for assessment of radiation illness symptoms.

IS #7


Augment patient and victim tracking. Identify by card, wristband, temporary tattoo or other means those that are high priority for myeloid cytokines treatment

IS #6


Identify persons with mild/moderate ARS for evacuation over next 10 days to other jurisdictions/networks for ongoing assessment / care and provide lists of these persons by shelter/location to EOC for evacuation planning.



Receive SNS assets including cytokines, distribute, and begin administration (daily) to those with at-risk symptoms.



Augment reunification hotline as needed (ideally a national number via ARC or Federal at this point)

IS #10


Provide instructions for public on self-decontamination- who needs it and how to do it.

IS #16


Mass fatality unit assures obvious bodies collected and transported to processing area
Inform public that saving lives and providing care to living are first priorities.

IS #12


Support transfer and tracking of victims and potential victims of acute radiation syndrome to regional, NDMS, and RITN centers for management in conjunction with EMS, EM, and medical.

IS #15


Reinforce PPE use by responders in areas of heavy structural damage. With OSHA and environmental health assistance initiate air monitoring for particulate debris and other hazards



With Federal and environmental health partners continue to map and monitor radiation levels



Assess safety of tap water



Medical System Response


Maintain situational awareness, including for AC, MC sites



Pass resource requests to appropriate EOC / other channels and provide feedback about expected timeframe of arrival



Work with hospitals to identify patients for transfer to regional facilities, NDMS, RITN centers or burn facilities. Develop lists for PH/EOC planning of evacuation

IS #15



Assure adequate supplies of medications, blood products, etc.



Activate resource-sharing plans throughout health system- including distant locations including bringing in supplemental.



Activate resource-sharing plans throughout health system- including distant locations including bringing in supplemental staff



Maintain fairness across the region and medical systems by attempting to distribute resources and patients and providing consistent guidance on triage in conjunction with PH

IS #14


Provide support for patient evacuation



Match arriving Federal, MRC, and other personnel with facilities / sites in need



Contribute status report to jurisdictional incident action plan via PH / HMCC



Emphasize need for timely treatment with myeloid cytokines of early ARS victims



Facilitate evacuation of damaged hospitals



Evacuee Medical Care and Fallout-related Radiation Illness


Continue mass evacuation and self-evacuation based on official guidance



Follow recommendations on self decontamination

IS #16


Remember physical location of shelter, time spent there, and onset/duration of any symptoms- for triage purposes.



Screen persons in MD or DF zone at AC or MC for ARS symptoms – initiate treatment with myeloid cytokines as soon as possible if mild/moderate symptoms



Move people out of shelters to other facilities/communities as soon as possible





Assess radiation and plume modeling and data to guide response and plans for recovery including access to certain areas for damage assessment. (what) Can define areas that will have NO radiation and remain useable without evacuation and radiation clean-up.



Improve situational awareness for damaged areas, utilities and affected infrastructure



Continue debris removal to facilitate traffic flow and restore services



Implement ‘cellular on wheels’ (COW) and public safety portable repeaters as needed in areas where EMP has damaged equipment to restore basic communications (in addition to amateur radio)



Emphasize community resilience and neighbor helping neighbor



Begin to resume retail and other functions, especially in unaffected places.



Assure that registry process is consistent with Federal expectations and shared with state(s) to allow follow-up care as well as for long-term cancer risk



Activate psychological support teams for public at large and continue support for responders and healthcare providers.

IS #13


Provide hotlines (located at national level), shelter-based support, and psychological triage / initial treatment to degree possible



Continue to work with utilities and private sector to prioritize service restoration


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  • This page last reviewed: August 16, 2012