A methodology for improving throughput using portal monitors

Using the Grade Approach to Support the Development of Recommendations for Public Health Interventions in Radiation Emergencies

The World Health Organization (WHO) guideline development policy requires that WHO guidelines be developed in a manner that is transparent and based on all available evidences, which must be synthesised and formally assessed for quality. To fulfil this requirement, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach of rating quality of evidence and grading strength of recommendations was applied when developing the WHO recommendations on public health interventions in radiation emergencies. The guideline development group (GDG) formulated 10 PICO (P: population; I: intervention; C: comparator; O: outcomes) questions to guide the development of recommendations on response interventions during the early/intermediate and late emergency phases and on risk communications for mitigating psycho-social impact of radiation emergencies. For each PICO question, an extensive evidence search and systematic review was conducted. The GDG then formulated the recommendations using the evidence to recommendation (E-2-R) decision-making matrix and evaluated the strength of each recommendation.

Modeling population screening process for maximizing throughputs

Following a large-scale radiation emergency, affected populations will need to be screened soon after for potential contamination (external or internal). Effective management of the available resources can help maximize the screening throughputs. This paper reports the modeling results for screening throughputs in a population screening center using a set resource, considering two major variables, the arrival rate (number of people arriving at the screening center per minute) and the contamination probability (the probability of finding a contaminated group). Both the full process (including all sub-processes in a population screening center) and the core process (including only the screening sub-processes: pre-screening, portal monitoring, and whole body counting) were simulated. As expected, for both processes, as the arrival rate increases, the screening center can get overwhelmed. Interestingly, the contamination probability becomes a significant factor for screening throughputs only when the arrival rate becomes high. The results show that following an emergency, when the arrival rate is high, much more resources will need to be deployed to the population screening center or multiple screening centers will need to be established.

Canada's efforts in developing capabilities in radiological population monitoring

Population monitoring is an important component of radiological and nuclear emergency preparedness and response. Since 2002, Canada has been investing in developing national capabilities in radiological population monitoring. This paper summarizes Canada's efforts in developing methods and techniques in biological dosimetry and in vivo and in vitro bioassay techniques. There are still many gaps to fill that require further efforts. Integration of different monitoring methods and techniques in order to have the best assessment of radiation dose to support medical management and integration of Canada's efforts with international efforts are recommended.

Psychosocial considerations for mass decontamination

Mass exposure to explosions, infectious agents, foodborne illnesses, chemicals or radiological materials may require mass decontamination that have critical psychosocial implications for the public and for both traditional and non-traditional responders in terms of impact and of response. Five main issues are common to mass decontamination events: (i) perception, (ii) somatisation, (iii) media role and communication, (iv) information sharing, (v) behavioural guidance and (vi) organisational issues. Empirical evidence is drawn from a number of cases, including Chernobyl; Goiania, Brazil; the sarin gas attack in Tokyo; the anthrax attacks in the USA; Three Mile Island; and by features of the 2003 severe acute respiratory syndrome pandemic. In this paper, a common platform for mass casualty management is explored and suggestions for mass interventions are proposed across the complete event timeline, from pre-event threat and warning stages through to the impact and reconstruction phases. Implication for responders, healthcare and emergency infrastructure, public behaviour, screening processes, risk communication and media management are described.

Considerations in screeneing/measuring children with internal/external contamination

The National Internal Radiation Assessment Section, which operates the Canadian National Calibration Reference Centre for Bioassay and In Vivo Monitoring, has field deployable equipment for emergency response. A substantial part of this toolkit is a set of portal monitors that can be used to quickly screen people into 'uncontaminated' and 'contaminated'. The former term refers to a person who has <60 kBq (empirical practical detection limit) of activation/fission products and the latter group is contaminated by that amount or more. Previous work has focused on how to process large numbers of people quickly and methodologies have been previously published; however, it was assumed that the group being monitored was composed of healthy adults. When applying these methods to children, a number of shortcomings have been identified.