Treating radiation injuries in US travelers returning from Japan

March 22, 2011 — In response to the crisis in Japan, the US Centers for Disease Control and Prevention (CDC) hosted a conference call for clinicians to answer questions about treating radiation injuries in US travelers returning from Japan.

During the hour-long Clinician Outreach and Communication Activity call yesterday evening, Jeffrey Nemhauser, MD, who is a captain in the US Public Health Service and a medical officer in the CDC’s Radiation Studies Branch, answered questions from healthcare providers about radiation exposure and treatment.

Dr. Nemhauser stressed that the CDC is not aware of any US travelers returning from Japan who have been “contaminated with material at a level of concern.” If a traveler is contaminated, the CDC will recommend decontamination, collect data, and follow-up with the traveler, he said.

Customs officials routinely screen travelers (and their luggage) entering the United States for radiation contamination, he said. Because of the radiation leaks in Japan, however, the CDC is creating extra screening protocols for airports. Dr. Nemhauser said that these protocols should go into effect this week.

Medical Resources Strained in Japan

 March 17, 2011 — The devastating magnitude 9.0 earthquake and tsunami that occurred in Japan’s Miyagi prefecture on March 11 have caused a cascade of health and safety problems for survivors, including possible exposure to radiation from the region’s damaged Fukushima Daiichi nuclear plant. The disaster has strained medical resources on the ground, but it is unclear how many resources will be needed in the future.

“This is a very complex disaster, and it’s an evolving, ongoing situation,” Kristi L. Koenig, MD, director of the Center for Disaster Medical Sciences at the University of California–Irvine, told Medscape Medical News.

“The recovery phase of this disaster is going to be years and years and years,” she said. “They need people over the next many months to years to help, because the whole public health infrastructure is disrupted.”

Japan’s experience has been very different from Haiti, where a magnitude 7.0 earthquake struck in January 2010 and created a vast need for medical help. “In Haiti, the existing healthcare infrastructure was basically nonexistent,” Dr. Koenig said, “and the building codes for earthquakes were not anywhere near what they are in Japan.”

Unlike Haiti, Japan has well-organized civil defense teams that helped victims immediately until outside help was available, Dr. Koenig pointed out. These factors likely mitigated the injuries and deaths from the earthquake in Japan.

“Japan has significant emergency management capacity — one of the best in the world,” Margaret Aguirre, director of global communications for the International Medical Corps, told Medscape Medical News in an email.

Future Clinical Assistance May Be Needed

Disaster Medicine Core Competencies for Emergency Physicians, Nurses and EMTs

Blog Post by Carl H. Schultz, MD, Professor of Emergency Medicine

The specialty of disaster medicine continues to grow and mature.  Journals dedicated to this field of study as well as textbooks now exist.  In fact, ACEP has recently endorsed a new reference text published by Cambridge University Press entitled Koenig and Schultz’s Disaster Medicine:  Comprehensive Principles and Practices.  Ideally, this body of scientific data would lead to development of a standard set of clinical competencies for those involved in the initial evaluation and treatment of disaster victims.  This is needed to ensure that effective emergency medical response can be provided efficiently during all types of disaster events.  Creation of broadly-recognized standard core competencies to support development of disaster response education and training for specific healthcare professionals will help to ensure that medical personnel are truly prepared to care for victims of mass casualties.  Nonetheless, a widely supported standardized set of core competencies for emergency physicians, nurses, and pre-hospital EMS personnel is currently lacking. 

Third National Congress of Health System Readiness: Disaster Medicine and Public Health Preparedness in the 21st Century

Blog Post by Kristi L. Koenig, MD, FACEP, Professor of Emergency Medicine, Director of Public Health Preparedness, Director, International Disaster Medical Sciences Fellowship, http://www.ucihs.uci.edu/emergmed

On December 1st in Washington DC nearly 500 physicians and others involved in public health preparedness gather at a joint session of the American Medical Association and the federal Department of Health and Human Services during the Third National Congress of Health System Readiness:  Disaster Medicine and Public Health Preparedness in the 21^st Century .  The session, delivered by senior government officials and academicians, is entitled “Medical Countermeasures:  From the Bench to the Bloodstream.”  This follows a full day of presentations that focused on using science to inform evidence-based preparedness for disasters of all types.  Highlights included an update on the threat and management of terrorist bombings, current concepts in mass casualty triage, and a fascinating international presentation about terrorist attacks and health system surge capacity with senior health and policy representatives from Israel, London, Madrid and Mumbai.  These provocative presentations were followed by interactive discussions with the audience, several of whom were contributors to the newly published Koenig and Schultz’s Disaster Medicine: Comprehensive Principles and Practices .  I look forward to future discussions with experts on the H1N1 pandemic.  The Congress concluded with several sessions focusing on the future of public health preparedness to include a special panel on education and training.