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Screening Travelers for Radiological
ContaminationPerspective from the National
Alliance for Radiation Readiness
Overview of the NARRTravelers Screening - 2011NARR Tabletop ExerciseTravelers Screening - 2014
Outline
Disclaimer: Information contained in this document does not constitute advice and does not represent the views of CDC or the U.S. Department of Health and Human Services. Use of any provision herein should be considered only in conjunction with advice from legal counsel. Provisions may need to be modified, supplemented, or replaced to ensure appropriate citation to, or compliance with, relevant laws or to otherwise address the needs or requirements of a specific jurisdiction.
A coalition of organizations committed to improving the nation’s ability to prepare, respond, and recover from radiological emergencies at the local, state, and national levels◦ 15 Member Agencies◦ 10 Federal Partners◦ Administered by the ASTHO through a cooperative
agreement with the CDC , National Center for Environmental Health, Radiation Studies Branch
National Alliance for Radiation Readiness (NARR)
NARR Membership American Association of Poison
Control Centers (AAPCC)
American Hospital Association (AHA)
Association of Public Health
Laboratories (APHL)
Association of Schools of Public Health
(ASPH)
Association of State and Territorial
Health Officials (ASTHO)
Conference of Radiation Control
Program Directors (CRCPD)
Council of State and Territorial
Epidemiologists (CSTE)
Health Physics Society (HPS)
International Association of
Emergency Managers (IAEM)
National Association of County and
City Health Officials (NACCHO)
National Association of State EMS
Officials (NASEMSO)
National Disaster Life Support
Foundation (NDSLF)
National Emergency Management
Association (NEMA)
National Public Health Information
Coalition (NPHIC)
Society for Disaster Medicine and
Public Health (SDMPH)
Centers for Disease Control and Prevention (CDC)
Office of the Assistant Secretary for Preparedness and
Response/US Department of Health and Human Services
(ASPR/HHS)
US Department of Homeland Security (DHS)
Environmental Protection Agency (EPA)
US Department of Energy (DOE)
US Department of Agriculture (USDA)
Food and Drug Administration (FDA)
US Nuclear Regulatory Commission (NRC)
Federal Emergency Management Agency (FEMA)
Federal Partner Agencies
To serve as the collective “voice of health” in radiological preparedness through the:◦ Participation in national dialogues on radiological
emergency issues◦ Provision feedback on documents, policies, and
guidelines◦ Convening of partners to raise awareness of
and resolve radiological emergency issues To build radiological emergency
preparedness, response and recovery capacity and capabilities
NARR Purpose
www.radiationready.org
Forum for sharing resources, tools, and best
practices related to radiation planning,
response, recovery
NARR Clearinghouse
Interactive Sessions/Webinars◦ Poison Control Center Collaborations with Public
Health- 2013◦ Radiation and Public Health Legal Considerations-2013◦ REP/Hostile Action Based Exercises- forthcoming 2014
Laboratory Prioritization Considerations Medical Community Education Project Passenger Screening
◦ Tabletop Exercise◦ Development of New Guidelines◦ Functional Exercise forthcoming
Recent and Upcoming NARR Projects
Traveler Screening- Federal Agencies
DHS, US Customs and Border Protection (CBP) DHHS, CDC, Division of Global Migration and Quarantine (DGMQ)
DHHS, CDC, Division of Environmental Hazards and Health Effects (EHHE)
CBP routinely employs a variety of radiation-
detection technology at POEs to detect the
presence of radioactive materials or
contamination.
◦ Use personal radiation detectors
◦ To locate the source of an alarm, CBP officers use
radiation isotope-identification devices to identify
level and type of radiation to determine source
Passenger Screening Procedure
March 12-16, 2011◦ No comprehensive radiological contamination screening
plan◦ CBP identified three externally contaminated travelers
March 23, 2011 CDC and CBP implemented entry screening at POE ◦ Enhanced screening at the mainland airports receiving
direct flights from Japan. March 23 to April 30, 2011, CBP used the protocol
to screen approximately 543 000 travelers for radioactive contamination who were arriving directly from Japan at 25 US airports ◦ no travelers with contamination levels that warranted a
public health response.
Travelers Screening
Traveler with Radioactive Contamination Detected by US Customs and Border
Protection (CBP)
Counts ≤2xBackground
Counts >2x and <20xBackground
Counts ≥20xBackground
Change Clothes and Rescreen
CBP/CDC Contacts State Radiation Control Immediately
State Radiation Control Assessment and Possible Intervention
Potential Follow-up Activities:o Radiation rescreeningo Epidemiologic assessmento Urine collection for CDC
bioassay
Passenger Released with Information
State Public Health and Radiation Control Perform Follow-up
CDC Contacts State Public Health
CBP Sends Contact and Screening Information to CDC
Traveler Released with Information
<2x Background >20x Background
If consent obtained >2x and <20x Background
Public Health Follow-Up CDC disseminated guidance and tools to
state radiation control programs and state
and local public health officials.
◦ epidemiologic assessment form
◦ recommendations for state radiation control
program officers
◦ materials and instructions for collecting urine
specimens
Performed by radiation control program
◦ External decontamination
◦ Epidemiological assessment
◦ Thyroid count
◦ Bioassay
Follow-Up Assessment
At the airport◦ Wash hands and face◦ Change clothes
At home◦ Full shower◦ Repeat gentle washing◦ No special considerations for drain water or
shavings Confirmed effectiveness by state radiation
control program
External Decontamination
Contact information
Flight information
Proximity to source release
Travel details
Epidemiologic Assessment Form
Gamma detection instrument next to the
patient’s neck
If patient’s thyroid count is higher than
background, it is indicative of radioactive
iodine uptake
◦ Follow up with their physician for clinical
evaluation
Thyroid Count
Urine bioassay can help identify if a traveler
has internal contamination
◦ Subset of travelers who were close to the source
Bioassay
Purpose◦ Identify key activities associated with traveler
screening at an airport following an incident involving radiological contamination in another country
◦ Validate and identify improved passenger screening protocols
Goal◦ Enhance preparedness of federal, state, and local
responders responsible for coordinating and conducting traveler screening at US airports following a radiological release
Traveler Screening Tabletop Exercise
Emergency operations and coordination Emergency public information and warning Information sharing Non-pharmaceutical interventions Public health surveillance and
epidemiological investigation Responder safety and health
Public Health Capabilities
Understand and/or identify state and local response requirements
Clarify response roles and communication channels
Inform next steps from epidemiologic assessment
Identify key topics for public information releases
Identify information to distribute to passengers and those potentially exposed at the airport
Exercise Objectives
Explosion at a nuclear power plant in South
Korea
Prior to screening passengers are boarding
flights headed to the U.S.
◦ 261 passengers on Plane 1
◦ 290 passenger on Plane 2
Both flights will land in 18-20 hours from
now
Scenario
How would notification occur?◦ Which agencies?◦ Which agency is the lead agency?
What protocols exist?- Passenger screening?- Decontamination?- Lab testing?- Passenger information?
Who will staff the arrival of the flights?
Emergency Management Questions
Calls from the families of passengers◦ Is my family member safe?◦ Have they been exposed?◦ Will they expose me?◦ What should I do with their luggage?◦ Can we get potassium iodide?
Questions from airport staff Questions from the public
Communication Questions
How will passengers be processed as they deplane?◦ Screening for internal/external contamination
Will the passengers be isolated as they deplane?
Which local/state public health authority and statues can be enforced?
Are there any precautions taken to protect airport workers?
Screening and Epidemiological Assessment Questions
Will the passengers be asked to provide clinical samples?◦ How will they be processed, transported, and
reported? What data should be collected along with
the samples for prioritization in analysis? Who will cover the cost of sample testing?
Bioassay Questions
What if a passenger refuses screening? Who will cover the cost of laboratory testing
and follow- up tests? If a passenger misses a connecting flight
due to screening and is stranded, who is responsible for hosting the passenger?
Legal and Financial Questions
Provides a cohesive guidance document to
address screening and decontaminating
travelers as necessary during a radiological
contamination release in another country.
Addresses all Ports of Entry into the U.S.
Travelers Screening Initiative
4 work groups
◦ Emergency Management
◦ Epidemiology/Surveillance
◦ Bioassay
◦ Communications
Travelers Screening Initiative
Finalization of drafts to occur in late April
Final draft version to be cleared by CDC and
DHS
Travelers Screening Initiative