Disaster Wk 6

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Week 6: Simulation Exercise – First 48 Hours

Discussion Questions:  450 words

Based on the information provided, participate in the discussion concerning the issues raised in Week 6. Identify any additional requirements, critical issues, decisions, or questions.

  1. What are the public health and medical agencies, short-term, intermediate, and long-term priorities?
  2. What federal agencies should be requested or might automatically respond to this incident?

 

Simulation Exercise Scenario:

The Next Two Days – Population and Environmental Impacts

May 1, 2021, at 8:30 AM, fire and law enforcement personnel responding to the incident scene are aware that an explosion has occurred that is not normal, and they have suspected that it is a nuclear explosion. They are detecting high levels of radiation, and it appears that some sort of nuclear explosion has occurred. There is a small mushroom cloud in the area.

The Incident Commander (IC) has asked for additional mutual aid resources. The IC is requesting the Oklahoma National Guard 63rd Civil Support Team (CST) be deployed immediately along with other neighboring response organizations.

  • By noon, the public, facilities, and hospitals receive notice to begin evacuating out of the Dangerous Fallout (DF) zone.
  • Many citizens have self-evacuated and are leaving Bobs ville for a more secure environment.

May 1, 2021, at 9:00 AM, Bunnyville hospital initiated START triage as soon as victims began arriving at the hospital. Bunnyville hospital reports many citizens arriving at the emergency room without any physical impacts, but they demonstrate significant psychological effects. Bunnyville Hospital is already overwhelmed with victims who have presented with severe injuries. They have implemented START triage for all patients to include those with psychological or mental health issues. Bunnyville hospital is separating the physically injured and are placing the mental health patients in a holding area and are classifying them as green or delayed patients.

May 1, 2021, at 1:00 PM, Incident Command recommends the local college gymnasium be utilized as a temporary casualty collection point. This site offers sufficient space allocation, brick structure for shielding, accessibility, and amenities needed to support a casualty collection point.

May 1, 2021, 2:00 PM, a meeting is held with elected leaders, public health officials, hospital leadership, law enforcement, and community advocates/leaders.

  • The discussion is about high public anxiety over radiation and diminished understanding of the associated risks and protective actions implemented.
  • There is increased demand for messaging and information even at points distant from the incident.
  • Elevated behavioral health impacts already exist within the impacted population as public fear of radiation has resulted in many concerned, healthy citizens seeking medical assistance.
  • If not mitigated radiological fear, and mental health issues will quickly add to the already overwhelmed limited medical facilities. Medical facilities impacted by the concerned yet healthy citizens will continue to affect capability and capacity to assist the sick and wounded.

By May 1, 2021, at 3:00 PM, patient fatalities have exceeded the capacity of the hospital morgue and the county medical examiner’s office.

Bobsville receives notice that a crude 1kt (kiloton) nuclear device appears to be the cause of the detonation. Currently, there is no information available as to who is responsible.

May 2, 2021, 8:00 AM, the Governor of the State of Oklahoma has prioritized the following response mission actions:

  • Lifesaving,
  • Life-sustaining,
  • Mental health,
  • Property protection,
  • Other measures intended to neutralize the immediate threat to life, environment, and property to achieve community stabilization.

The State of Oklahoma has also activated multiple units of the National Guard to respond to the impacted area of Bobsville.

  • Activated National Guard will provide mass care, critical transportation, and evacuation support resources to the community. Additionally, at the request of the Bobsville Incident Management Team Incident Commander, the Governor has requested any National Guard medical personnel with a background in mental health treatment or psychological first aid to be activated.
  • The National Guard is also assisting with scene security, and several additional Civil Support Teams (CST) have been requested and are en-route from other locations. The CST teams will support monitoring operations until other Federal agencies have arrived on the scene.

The State of Oklahoma has asked for assistance from the National Disaster Medical System with Disaster Mortuary Operation Response Teams (DMORT) to assist with identification, evidence collection and decontamination of deceased victims.

Mass Care of citizens, responders and domestics pets is a priority, and some agencies have already begun to arrive and have established mass care functions at Reception Care Centers (RCC).

  • Decontamination needs for mass care will place additional constraints on responder resources. In some cases, decontamination standards will need to be adjusted to allow entry and reentry into shelters or RCC’s.
  • Planning has begun for short and long-term domestic contamination migration issues due to unmonitored and uncontrolled movement of people, household pets and service animals, and transportation conveyances outward from the Bobsville, which could cause cascading challenges across multiple jurisdictions. GCPHD has begun to implement different surveillance methods to identify and track victims/patients/citizens that may have been exposed to radiation.
  • Additionally, GCPHD has implemented surveillance systems to track individuals who may be presenting with mental health issues.
  • Children continue to be sheltered-in-place at schools and have been anxious to be reunited with their parents and parents with their children.  Some parents have not yet been located, which has created some complexities.
  • Some individuals did not receive the evacuation order. First responders have been attempting to locate all citizens still sheltering-in-place to be evacuated and relocated to [preidentified] Reception and Care Center (RCC) locations outside the hazard zone.

Environmental assessments and consequences have been evaluated and may include contamination of ground and water systems (natural and distributed).

  • Residual radioactivity in the environment (e.g., waterways, livestock, forests, agricultural land, and wildlife) may affect the food supply and drinking water.
  • Stormwater runoff may contaminate retention basins, stormwater management systems, and larger waterways, affecting drinking water.

Key Issues

  • During these 48 hours, hospital EDs and community health center clinics are above surge capacity.
  • A Casualty Collection Point is established at the college.
  • Residents, schools, and other locations have been sheltering-in-place but now have been instructed to begin evacuation procedures.
  • Civil Support Teams have arrived and are providing technical expertise to Incident Command.
  • Mental health issues and psychological first aid requirements for citizens are overwhelming the health care infrastructure.
  • Children are in the process of being reunited with located parents/guardians.
  • Bobsville and General County have begun to receive medical assets, food and evacuation assistance coordinated through the first responders, National Guard, the American Red Cross, state and local public health agencies.

Examples Below:

What are the public health and medical agencies, short-term, intermediate, and long-term priorities?

Public health and medical agencies short-term goals would be to provide lifesaving and life sustaining measures to victims. intermediate goals would be to provide safe shelter, food and water and help with evacuation efforts. The long-term priorities would be community stabilization.

What federal agencies should be requested or might automatically respond to this incident?

The federal agency that should be requested or might automatically respond to this incident is NIMS, which is the National Incident Management System. NIMS provides all levels of government and private sectors with systems and processes during an emergency (FEMA, 2023).  Another agency that should be requested is the HHS, which is the Department of Health and Human Services. Also, NEST, which is the Nuclear Emergency Support Team (U.S Department of Energy, 2023). Social services may want to be brought in to help with the mental health crisis along with local Ministeries.

FEMA, (2023, June 22). National Incident Management System | FEMA.gov. FEMA. https://www.fema.gov/emergency-managers/nims

U.S Department of Energy,  (2023, July 6). Nuclear Emergency Support Team (NEST) | Department of Energy. Energy. https://www.energy.gov/nnsa/nuclear-emergency-support-team-nest

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What are the public health and medical agencies, short-term, intermediate, and long-term priorities?

In accordance with the Governor of the State of Oklahoma’s prioritized mission actions. Public health and medical agencies must follow suit until further guidance is issued.

Short Term Priority:

-First and foremost, lifesaving. Assessing patients through continued START triage within clinics, hospitals and community health centers.

-Move patients who are in drop zone to casualty collection points to ensure no further harm is caused.

-Continued efforts to separate the mental health patients from the physically injured.

-Public health officials should begin pushing more information to the public indicating new guidance on the reception and care center (RCC’s).

-Requests for telehealth options supported by external healthcare facilities within the state to aid in influx of healthy patient arriving to emergency departments.

 

Intermediate Priority:

-Children who have been ordered to shelter in place should be moved to RCC’s and every effort should be utilized to reunite them with their families if possible. In cases that parents or other family members cannot be located, a medical or mental health provider should stay with them to aid in the increased fear and anxiety at this time.

-Secondary triage of mental health patients. Utilization of National Guard medical providers to aid in sorting and treating these patients.

-Logistical concern of space as patients continue to burden ED. Determine location and set up of possible field hospitals or other buildings for use outside of drop zone (utilization of National Guard to aid this gap).

** Begin thinking about locations in which decontamination centers can be set up.

 

Long Term Priority:

-Establish and equip decontamination centers for affected community members and pets.

-Provide guidance to community as to the locations of decontamination shelters as well as assignment to a set center to aid in tracking and prevent cross jurisdiction.

-Further logistical concerns: supply replenishments and additional food and water to those in current field hospitals, RCC’s and in hospitals.

-Continued collection at local college gym for casualty collection point.

-Establish plan to clean up contaminated soil and water.

-Educate community on the contamination and mitigation efforts until spill clean-up and recovery is completed.

 

What federal agencies should be requested or might automatically respond to this incident?

The National Contingency Plan should be automatically instituted in any case of spill or release of hazardous material. The NCP consists of various entities; however, in our case, the regional response teams, as well as the national response teams, should be activated. FEMA is another agency that can be requested in our given case. Health and Human Services (HHS) may also assist in managing public health and response assistance. In regards to the environmental concerns, additional resources may be available via:

Environmental Protection Agency (EPA

The Department of Agriculture (USDA)

The Soil Conservation Service (SCS).

The Animal and Plant Health Inspection service (APHIS)

-Department of the interior (DOI)

Fish and Wildlife Service (USFWS)

Geological Surveys

 

References:

Major Radiological and Nuclear Health and Medical Considerations – hhs.gov. (n.d.-a). https://files.asprtracie.hhs.gov/documents/aspr-tracie-radiological-and-nuclear-health-and-medical-considerations-508.pdf

National Incident Management System – fema.gov. (n.d.). https://www.fema.gov/sites/default/files/2020-07/fema_nims_doctrine-2017.pdf

Legal Information Institute. (n.d.). 40 CFR § 300.170 – federal agency participation.Legal Information Institute. https://www.law.cornell.edu/cfr/text/40/300.170

Legal Information Institute. (n.d.-b). 40 CFR § 300.175 – Federal Agencies: Additional responsibilities and assistance. Legal Information Institute. https://www.law.cornell.edu/cfr/text/40/300.175

What are the public health and medical agencies, short-term, intermediate, and long-term priorities?

Short term priorities should we saving as many lives as possible! Implementing the START triage protocol or mass casualty protocol. The number one concern is to get victims shelter, safety, and the medical attention they require.

Intermediate priorities would be managing clean up from the disaster. Ensuring debris are cleared so that life could resume. The debris being cleared will ensure any deceased can be located and retuned to the family to avoid any public health issues. An  after actions report should also be done to receive feedback on how all the working parts worked together.

Long-term would be monitoring the health of those exposed to make share continuation of care is followed up on. At this time taking what was discussed in the after actions report to make the necessary process improvement to be more effective should also be a priority.

What federal agencies should be requested or might automatically respond to this incident?

In this specific scenario Under the Homeland Security Act, DHS has control of the Nuclear Incident Response Team (NIRT). DHS/CBP coordinates the Federal response for incidents involving the inadvertent import of radioactive material. The National Incident Management System (NIMS) guides all levels of government, nongovernmental organizations and the private sector to work together to prevent, protect against, mitigate, respond to and recover from incidents.

Work Cited

Fema.Gov, www.fema.gov/sites/default/files/documents/fema_nuc-detonation-planning-guide.pdf. Accessed 11 July 2023.

“National Incident Management System.” FEMA.Gov, www.fema.gov/emergency-managers/nims#:~:text=The%20National%20Incident%20Management%20System,to%20and%20recover%20from%20incidents. Accessed 11 July 2023.

  1. What are the public health and medical agencies, short-term, intermediate, and long-term priorities?

    First and foremost, scene safety is paramount when many lives are lost during an incident. The scene should be rendered safe before we have all sorts of first responders entering. In the incident of an explosion, the explosive ordinance disposal team needs to confirm that there is not a risk of another explosion happening. Securing the scene should be the priority on the short-term goals. Evacuation of surviving victims and people in the surrounding areas of the incident should be considered next. Evacuation will allow more lives to be saved as they are removed from a potentially dangerous area. After the scene is secured, first responders can start the START triage process, which is the third short-term priority I have listed.

    Intermediate priorities consist of casualty collection, re-unification of surviving victims, victim identification, and evidence collection. These can all occur after the scene is rendered safe and all personnel are accounted for. At the time of casualty collection and re-unification, there is no longer a threat and there is time to focus on these tasks. Victim identification and evidence collection are not a first priority. Once again, safety is always first. Prioritizing victim identification and evidence collection over the medical assessment of victims could cost more lives than save them.

    Lastly, long term priorities occur after the scene is clear and even after the explosion starts to be cleaned up. Survivors sustain more injuries than just physical when it comes to an explosion, there is an entire mental health aspect to consider. Next, the decontamination of radiation in the waterways, food supply, wildlife, and land should be considered as a long term goal. This is a long term goal because it may take days, months, or years of monitoring before deeming the environment safe from radiation

    2. What federal agencies should be requested or might automatically respond to this incident?

The state’s National Guard should be dispatched as the first federal agency to assist local law enforcement and medical personnel. Secondly, the Department of Energy’s Federal Radiological Monitoring and Assessment Center (FRMAC) should be dispatched to the area to monitor radiation levels. Thirdly, the Federal Emergency Management Agency should respond to assist and monitor how the local agencies are responding to the incident.

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What are the public health and medical agencies, short-term, intermediate, and long-term priorities? 

Short-term priorities:

Public health and medical agencies often have several objectives that change depending on the individual requirements and conditions of the people they serve. While I can offer an outline of the priorities, it is crucial to remember that they may differ among nations and areas. During a crisis or epidemic, authorities control the immediate threat and provide emergency medical assistance. Data gathering and analysis to track the spread of disease, detect patterns, and inform public health measures. Communicate accurate and timely information to the public to encourage knowledge, risk reduction, and acceptable health practices. Encourage and facilitate the distribution and administration of vaccinations to protect the population against infectious illnesses.

Intermediate priorities:

Implement efforts to prevent illness development and transmission, such as boosting hand hygiene, sanitation, and infection control practices. To lower the burden of noncommunicable illnesses, promote healthy behaviors such as physical exercise, balanced eating, and cigarette and alcohol management. Improve access to health care services, reduce obstacles, and focus treatments on vulnerable groups to address health inequalities and inequities. Create services to assist patients with chronic diseases, such as education, frequent tests, and access to inexpensive treatment. Assess and minimize environmental elements impacting air and water quality, food safety, and occupational risks.

Long-term priorities:

Supporting scientific research to expand medical knowledge, develop new medicines, and better disease preventive techniques. Improving healthcare systems’ total capacity and resilience, including infrastructure, personnel training, and technological integration. Advocating for evidence-based policies and regulations that benefit public health, such as tobacco control, health insurance reform, and food safety standards. Collaborating with foreign partners to solve global health concerns such as infectious illnesses, pandemic preparation, and health security. Promoting health literacy and education activities to enable people and communities to make informed health decisions.

What federal agencies should be requested or might automatically respond to this incident?

The government agencies responding to an event depend on the type and scope of the occurrence and the nation in the issue. However, many critical federal entities are responsible for reacting to many nations’ public health and medical events.

  • The Centers for Disease Control and Prevention (CDC) is a government organization in the United States that preserves public health and reacts to infectious disease epidemics. They give instructions, perform surveillance, and coordinate national reaction actions.
  • The FDA ensures the safety and effectiveness of food, pharmaceuticals, medical devices, vaccinations, and other items. They may examine and issue emergency use authorizations for medicines or vaccinations during a public health event.
  • FEMA is in charge of organizing and assisting with disaster response and recovery operations in the United States. They may give resources, logistical assistance, and funds to manage public health emergencies.
  • The DHS is responsible for defending the United States from many dangers, including public health catastrophes. They may assist in border control, transit security, and vital infrastructure protection.
  • The EPA is concerned with preserving human health and the environment. They may be involved in analyzing and mitigating environmental risks that may influence public health during an occurrence.

Reference

Piotrowski, S., Rosenbloom, D. H., Kang, S., & Ingrams, A. (2018). Levels of value integration in federal agencies’ mission and value statements: Is open government a performance target of US federal agencies? Public Administration Review, 78(5), 705–716. https://doi.org/10.1111/puar.12937

Al-Fayez, D., & Goodman, D. (2023). Health-Related Assistance Programs, Leadership Support, and Organizational Performance: Evidence From the U.S. Federal Agencies. Public Personnel Management. https://doi.org/10.1177/00910260231173082