THE RADIATION ONCOLOGIST’S ROLE IN PREPAREDNESS PLANNING Andrew L. Salner, MD FACR Director, Helen & Harry Gray Cancer Center Hartford Hospital, Hartford, CT p , , Chair, ASTRO Nuclear/Radiologic Response Committee
DISCLOSURES: NONE DISCLOSURES: NONE
OBJECTIVES OBJECTIVES After this session attendees will be able to: After this session, attendees will be able to: • 1 ‐ understand the importance of local hospital radiologic preparedness radiologic preparedness • 2 ‐ understand the components of a hospital radiation plan di i l • 3 ‐ understand the important and unique role of the radiation oncologist
WHY PREPARE? WHY PREPARE?-1 WHY PREPARE? WHY PREPARE? 1 � INCREASING LIKELIHOOD OF AN � INCREASING LIKELIHOOD OF AN INCREASING LIKELIHOOD OF AN INCREASING LIKELIHOOD OF AN EVENT EVENT � PUBLIC EXPECTS MEDICAL SYSTEM � PUBLIC EXPECTS MEDICAL SYSTEM PUBLIC EXPECTS MEDICAL SYSTEM PUBLIC EXPECTS MEDICAL SYSTEM WILL BE READY WILL BE READY- -BIOLOGIC AND BIOLOGIC AND CHEMICAL PREPARATION IS READY CHEMICAL PREPARATION IS READY � RESPONSES ARE FIRST AND RESPONSES ARE FIRST AND FOREMOST FOREMOST LOCAL LOCAL � SYSTEM(HOSPITALS, SYSTEM(HOSPITALS, ROADS,ER’S) ROADS,ER’S) NOT READY ROADS,ER S) ROADS,ER S) NOT READY NOT READY NOT READY
WHY PREPARE? WHY PREPARE?-2 WHY PREPARE? WHY PREPARE? 2 � OTHER HEALTH CARE PROVIDERS NOT � OTHER HEALTH CARE PROVIDERS NOT OTHER HEALTH CARE PROVIDERS NOT OTHER HEALTH CARE PROVIDERS NOT COMFORTABLE WITH RADIATION ISSUES COMFORTABLE WITH RADIATION ISSUES � COORDINATED LOCAL RESPONSE CAN COORDINATED LOCAL RESPONSE CAN OCCUR WITH PREPARATION OCCUR WITH PREPARATION � RADIATION ONCOLOGIST NATURAL RADIATION ONCOLOGIST NATURAL CHAMPION FOR THIS EFFORT CHAMPION FOR THIS EFFORT � MANY HOSPITAL DISASTER PLANNING MANY HOSPITAL DISASTER PLANNING EFFORTS LACKING IN THE EFFORTS LACKING IN THE RADIATION COMPONENT RADIATION COMPONENT
today’s presentation today s presentation today s presentation today’s presentation � Event likelihood � Event likelihood Event likelihood Event likelihood � Our hospitals and infrastructure Our hospitals and infrastructure � Hospital plan and team H Hospital plan and team H it l it l l l d t d t � Connecticut pilot Connecticut pilot � Role of radiation oncologist Role of radiation oncologist
LIKELIHOOD OF AN EVENT LIKELIHOOD OF AN EVENT LIKELIHOOD OF AN EVENT LIKELIHOOD OF AN EVENT � TERRORISM IS GROWING WORLDWIDE � TERRORISM IS GROWING WORLDWIDE TERRORISM IS GROWING WORLDWIDE TERRORISM IS GROWING WORLDWIDE � HIGH PROBABILITY OF RETURNING TO OUR HIGH PROBABILITY OF RETURNING TO OUR SHORES SHORES � RADIOACTIVE SOURCES READILY RADIOACTIVE SOURCES READILY AVAILABLE AVAILABLE � SPREADING FEAR AND PANIC, SPREADING FEAR AND PANIC, DISABLING OUR SYSTEMS, DISABLING OUR SYSTEMS, S S G OU G OU S S S S S, S, GETTING OUR ATTENTION, GETTING OUR ATTENTION, LOSS OF LIFE LOSS OF LIFE LOSS OF LIFE LOSS OF LIFE
WE HAVE HAD AN EXPLOSION WE HAVE HAD AN EXPLOSION IN BOSTON IN BOSTON IN BOSTON. THIS MIGHT BE A IN BOSTON. THIS MIGHT BE A THIS MIGHT BE A THIS MIGHT BE A DIRTY BOMB. IF YOU DIRTY BOMB. IF YOU EXPERIENCE HEADACHE, EXPERIENCE HEADACHE, NAUSEA, OR FATIGUE, NAUSEA, OR FATIGUE, NAUSEA, OR FATIGUE, NAUSEA, OR FATIGUE, PROCEED AT ONCE TO THE PROCEED AT ONCE TO THE NEAREST MEDICAL FACILITY NEAREST MEDICAL FACILITY NEAREST MEDICAL FACILITY. NEAREST MEDICAL FACILITY. (simulated story ( simulated story) y)
CHALLENGE OF AN EVENT CHALLENGE OF AN EVENT CHALLENGE OF AN EVENT CHALLENGE OF AN EVENT � ACCIDENT INCIDENT TERRORIST � ACCIDENT, INCIDENT, TERRORIST ACCIDENT INCIDENT TERRORIST ACCIDENT, INCIDENT, TERRORIST ACT ACT � LARGE DEMAND ON HEALTHCARE � LARGE DEMAND ON HEALTHCARE LARGE DEMAND ON HEALTHCARE LARGE DEMAND ON HEALTHCARE FACILITIES FACILITIES � VICTIMS POTENTIALLY EXPOSED VICTIMS POTENTIALLY EXPOSED VICTIMS POTENTIALLY EXPOSED VICTIMS POTENTIALLY EXPOSED AND/OR CONTAMINATED AND/OR CONTAMINATED � “WORRIED WELL” “WORRIED WELL” � MEDICAL AND PUBLIC HEALTH MEDICAL AND PUBLIC HEALTH ISSUES ISSUES
RADIATION INJURY RADIATION INJURY RADIATION INJURY RADIATION INJURY � EXPOSURE EXPOSURE � Acute Radiation Syndrome Acute Radiation Syndrome Acute Radiation Syndrome Acute Radiation Syndrome Hematopoietic/ GI/ CNS/ Cutaneous Hematopoietic/ GI/ CNS/ Cutaneous Subsyndromes Subsyndromes y � EXTERNAL CONTAMINATION � EXTERNAL CONTAMINATION EXTERNAL CONTAMINATION EXTERNAL CONTAMINATION � INTERNAL CONTAMINATION INTERNAL CONTAMINATION
SYSTEM SYSTEM READINESS READINESS � ER’S OVERCROWDED � ER S OVERCROWDED ER’S OVERCROWDED ER S OVERCROWDED � HOSPITALS FULL HOSPITALS FULL � LIMITED CAREGIVERS � LIMITED CAREGIVERS LIMITED CAREGIVERS LIMITED CAREGIVERS � ROADWAYS CONGESTED ROADWAYS CONGESTED � POPULATION EASILY AND QUICKLY � POPULATION EASILY AND QUICKLY POPULATION EASILY AND QUICKLY POPULATION EASILY AND QUICKLY PANICKED PANICKED � NOT SO READY!! NOT SO READY!!
� Nation's Emergency Care System Is Nation's Emergency Care System Is g g y y y y Fragmented, Unable To Respond To Disasters, Fragmented, Unable To Respond To Disasters, Says Institute Of Medicine Says Institute Of Medicine � only a tiny fraction of federal funding for only a tiny fraction of federal funding for l l i i f f i i f f d f f d l f l f di di f f emergency preparedness since 9/11 has been emergency preparedness since 9/11 has been spent on medical preparedness spent on medical preparedness spent on medical preparedness spent on medical preparedness � increasing responsibilities of hospital emergency increasing responsibilities of hospital emergency departments, which are caring for patients departments, which are caring for patients without medical insurance and for insured without medical insurance and for insured patients unable to access their physicians patients unable to access their physicians
ER STRESSORS ER STRESSORS IOM REPORT 6/06 IOM REPORT 6/06 IOM REPORT 6/06 IOM REPORT 6/06 � ER VISITS GREW BY 23% 1996 ER VISITS GREW BY 23% 1996- -2003 2003 � # ER’S DECLINED BY 425, BEDS BY 198,000 # ER’S DECLINED BY 425, BEDS BY 198,000 � ER’S CROWDED BY LACK OF INPATIENT ER’S CROWDED BY LACK OF INPATIENT BEDS(PTS BOARDED) BEDS(PTS BOARDED) BEDS(PTS BOARDED) BEDS(PTS BOARDED) � AMBULANCES FREQUENTLY DIVERTED AMBULANCES FREQUENTLY DIVERTED � POOR EMS COORDINATION � POOR EMS COORDINATION POOR EMS COORDINATION POOR EMS COORDINATION � SHORTAGE OF SPECIALISTS TO TAKE SHORTAGE OF SPECIALISTS TO TAKE ER/TRAUMA CALL ER/TRAUMA CALL � LITTLE OR NO SURGE CAPACITY LITTLE OR NO SURGE CAPACITY LITTLE OR NO SURGE CAPACITY LITTLE OR NO SURGE CAPACITY � SUPPLIES LACKING FOR PEDIATRIC SUPPLIES LACKING FOR PEDIATRIC EMERGENCIES EMERGENCIES EMERGENCIES EMERGENCIES
Transportation issues Transportation issues Transportation issues Transportation issues � US Dept of Transportation � US Dept of Transportation US Dept of Transportation US Dept of Transportation INCREASING CONGESTION IN CITIES
Highway Congestion Highway Congestion- -1 1 Federal Highway Administration Federal Highway Administration F d F d l Hi h l Hi h Ad Ad i i i i i i INCREASING HOURS OF DELAY IN CITIES INCREASING HOURS OF DELAY IN CITIES
Highway congestion Highway congestion- -2 2 F d F d Federal Highway Administration Federal Highway Administration l Hi h l Hi h Ad Ad i i i i i i REASONS REASONS FOR MORE CONGESTION
US National Guard US National Guard US National Guard US National Guard � EQUIPMENT SHORTAGE � EQUIPMENT SHORTAGE EQUIPMENT SHORTAGE EQUIPMENT SHORTAGE � Demands of wars since 9/11 Demands of wars since 9/11 strain strain National Guard s efforts National Guard s efforts National Guard's efforts National Guard's efforts � By Bryan Bender, Globe By Bryan Bender, Globe St ff St ff | S Staff Staff | September 2, 2005 S September 2, 2005 t t b b 2 2005 2 2005
Health Care Providers Health Care Providers N Not Well Informed Not Well Informed N W ll I f W ll I f d d � Physicians, nurses do not know much about radiation Physicians, nurses do not know much about radiation i i issues issues � ER physicians happy to manage patients but want ER physicians happy to manage patients but want knowledgeable radiation colleagues with them knowledgeable radiation colleagues with them � General fear about staff and facility contamination and General fear about staff and facility contamination and exposure exposure � Lack of understanding of difference between exposure Lack of understanding of difference between exposure and contamination and contamination � Compelling rationale for � Compelling rationale for Compelling rationale for Compelling rationale for local hospital radiologic local hospital radiologic preparedness team preparedness team preparedness team preparedness team
ER physician response ER physician response � “We are not “We are not taking any taking any radiation radiation radiation radiation patients patients- -we don’t we don’t have enough have enough have enough have enough shielding!” shielding!”
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