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