Disaster Medicine and Public Health Preparedness最新文献

Objective: Substantial investments have been made in hospital emergency preparedness. The Hospital Medical Surge Preparedness Index (HMSPI) has been proposed as a metric to assess health system readiness. This index summarizes hospital system characteristics, space and facilities, staff availability, and supply planning.

Methods: The primary objective was to evaluate the relationship between the HMSPI and characteristics of the respective hospitals, including size, type, location, performance on the Hospital Resilience Index (HRI), and Social Determinants of Health (SDoH).

Results: Higher HMSPI scores were found in suburban compared to rural hospitals, a higher HMSPI in larger hospitals with greater patient volumes and capacity (43.2 [42,44]) versus medium (26 [25,27]) and small (18 [17,19]) hospitals, and teaching status (29 [28,30]) versus non-teaching status (25 [25,26]). Investor-related hospitals and those caring for more patients with Medicare/Medicaid coverage had a lower HMSPI.

Conclusions: In conclusion, hospital medical surge preparedness is unevenly distributed across the U.S. health care system, with larger, not-for-profit, and teaching institutions having higher preparedness scores on the HMSPI, while a greater percentage of patients covered by Medicare/Medicaid is linked to lower scores.

Aim: This study aimed to develop a slogan poster designed to systematically inform individuals and encourage protective actions against Extreme Hot Weather Events (EHWE).

Methods: A quasi-experimental single-group pretest-posttest design was employed, following the TREND guideline. EHWE knowledge was measured before exposure (Measurement 1), immediately after exposure (Measurement 2), and 2 months later (Measurement 3). Fifty-seven participants completed Measurements 1 and 2, and 45 completed all 3. Repeated-measures ANOVA and Bonferroni-adjusted pairwise comparisons were conducted; qualitative feedback was collected after Measurement 2.

Results: Knowledge scores increased from Measurement 1 (M = 9.36, SD = 2.39) to Measurement 2 (M = 13.93, SD = 0.94), then decreased at Measurement 3 (M = 12.07, SD = 1.80), while remaining above baseline. ANOVA confirmed a significant effect of time (F[2.88] = 129.13, P < 0.001, partial η² = 0.70). Feedback indicated clarity and practicality, with suggestions for design improvements.

Conclusion: Poster exposure was associated with immediate knowledge gains, though a partial decline occurred by 2 months. Broader and controlled studies are needed to evaluate long-term effectiveness.

This study aimed to assess the situations involving potential risks of over-exposure to radiation faced by workers during the decommissioning of the Fukushima Daiichi Nuclear Power Plant (FDNPP), and to prepare effective medical countermeasures. While deaths have occurred at regular intervals at the FDNPP site, they cannot be attributed to direct effects of radiation. Radiation exposure among decommissioning workers is strictly maintained within regulatory limits, and no deterministic or stochastic radiation effects have been observed. High-risk areas include the reactor buildings of Units 1-4 and the filtration systems for cooling water contaminated by decay heat from melted nuclear fuel. The reactor buildings contain a mix of α, β, and γ radionuclides, which may increase the need for medical responses specifically targeting α radionuclides in cases of internal contamination. With nuclear fuel removal in September 2024, there are growing concerns regarding the potential increase in radiation risks at the decommissioning site.

Objective: We aimed to describe representative activities related to radiation risk management and community-based revitalization in Fukushima following the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident by chronological phase and provide an overview of effective recovery projects and future prospects.

Methods: We systematically reviewed projects and research on the FDNPP accident in PubMed. For convenience, we defined the first, second, and third phases as 2011-2014, 2015-2018, and 2019-2023, respectively. The main project, purpose, organization, core location, and validation in each phase after the disaster were briefly summarized.

Results: We found that lessons learned from the FDNPP disaster have been continuously and professionally conveyed across generations, regions, and nations by effectively disseminating easy-to-understand information, avoiding any misunderstanding and prejudice. A continuous flow of scientists, researchers, and trainees from Japan and abroad to the affected areas will create a positive cycle of attracting people and residents, eventually accelerating recovery and contributing to the development of safe and vibrant communities in disaster-affected areas.

Conclusions: Continued efforts are required to enhance expertise at the field level, strengthen organizational capabilities, and promote international cooperation, thereby ensuring that a similar nuclear accident never happens again.

Objectives: On June 6, 2017, an accident occurred at the JAEA's Oarai Research and Development Center, where 5 workers inhaled plutonium. This study aims to evaluate the validity of the internal dose assessments conducted by the QST and to share the findings with the dosimetry community.

Methods: In vivo measurements (lungs and liver) and bioassays were performed. The particle size of the inhaled material was estimated based on the ratio of early fecal excretion to residual lung content. The absorption types of Pu and 241Am were evaluated using urinary excretion levels from bioassay results of early fecal and pre-Ca- DTPA urine samples.

Results: The estimated particle sizes of the inhaled materials were over 10 μm and several micrometers for 2 workers, respectively. The absorption types were evaluated as intermediate between M (Moderate) and S (Slow). A change in urinary excretion levels between before and after Ca-DTPA administration was observed, with the most significant reduction occurring after the initial treatment, followed by smaller changes.

Conclusions: The internal dose assessments for the 5 workers were confirmed to be conservatively conducted within a reasonable range. Comprehensive individual monitoring in cases of internal contamination by actinide is crucial to reducing uncertainties in dose assessment.

Objective: Provide a systematic overview of assessment approaches for treatment decisions after internal contamination with plutonium, americium, or curium and the efficacy of decorporation treatment with diethylenetriamine pentaacetate (DTPA) among humans and animals.

Methods: MEDLINE, EMBASE, and Cochrane Library were searched until December 06, 2023. Controlled experimental animal studies and human studies were eligible. Hand search of relevant reports continued until December 24, 2024. Risk of bias was assessed with the OHAT and JBI critical appraisal tools. Narrative synthesis was performed.

Results: A total of 37 studies and 1 report were included. Two studies reported averted dose in humans following DTPA ranging from 150 μSv to 1.1 Sv, but the contribution of rapid contamination assessments to treatment decisions was unclear. Numerous outcomes across different treatment schedules and observation periods were studied in animal populations. Studies provided very low certainty evidence of positive treatment effects.

Conclusions: Whether rapid dose assessment contributes to timely treatment decisions could not be assessed with the limited amount of informative studies. In animal studies, DTPA treatment seems to be effective in reducing radiation burden and other proximal outcomes, but risk of bias is high. Evidence for humans is based on a small number of case studies where reductions in body burden have been reported.

The mission of the Radiation Studies Program (RSP) in the Centers for Disease Control and Prevention, National Center for Environmental Health, is to analyze scientific advances, educate the public, and build public health capacity for all communities in the US to reduce morbidity and mortality from unnecessary exposures to radiation-both in daily life and in the event of a radiation emergency. The program accomplishes these goals by collaborating with national and international partners and supporting scientific advancements in collaboration with national and international organizations.Since 2001, RSP has developed tools, training, and communication products to prepare and support local, state, tribal, and federal agencies in the US that are engaged in a response to a nuclear or radiological incident. This paper summarizes the latest RSP resources, which were presented during the 17^th REMPAN Coordination Meeting in Seoul, South Korea, on September 14, 2023.

Objectives: This article provides an overview of Korea's National Radiological Emergency Medical System, which coordinates medical responses to radiological emergencies through specialized infrastructure, training, and research.

Methods: The system's recent advancements are outlined, focusing on a nationwide network of emergency medical institutions and improvements in education, training, and research to enhance preparedness for radiological emergencies.

Results: The National Radiation Emergency Medical Center (NREMC) manages 31 designated emergency medical institutions, providing specialized training for first responders and medical personnel. Virtual reality tools have been integrated into training programs to improve instructional effectiveness. A hotline offers immediate support for radiation exposure cases and public consultations during non-emergency periods. Additionally, the NREMC employs internationally accredited physical and biological dosimetry methods and strengthens its expertise through collaborations with global organizations.

Conclusions: Continuous advancements in medical response, training, and international cooperation enhance Korea's radiological emergency preparedness. Ongoing research and technology integration ensure effective emergency interventions and long-term public health protection.

The European Radiation Dosimetry Group (EURADOS) and the WHO's Radiation Emergency Medical Preparedness and Assistance Network (REMPAN) have collaborated to review best practices for managing radionuclide intakes through wounds. Rapid response and decisions on wound decontamination, tissue excision, and chelation therapy are based on measurements of the exposed individual and preliminary dose assessments using reasonable default assumptions. The goal is to minimize exposure, prevent tissue reactions, and reduce the risk of stochastic effects.The management of a contaminated wound is always case-specific, but some general procedures typically apply for a proper evaluation of the contamination case. Medical doctors (surgeons and toxicologists) and internal dosimetrists should work together in the management of the contaminated wound case, with internal dosimetrists providing expert advice to aid clinical decision-making and communication with the patient and his/her family. The ISO standard 20031:2020 provides guidelines on the monitoring and dosimetry for internal exposures due to wound contamination with radionuclides. The Clinical Decision Guide was proposed by the National Council on Radiation Protection and Measurements in its Report 161 to assist physicians in making treatment decisions for individuals with internal radionuclide intakes. Best practices for medical treatment, based on previous experience, are presented here.

Accurate radiation dose measurement is crucial for medical intervention and protective actions. Biological dose assessment directly measures radiation-induced molecular and physiological changes, providing information about the absorbed dose and potential health risks. The Korea Institute of Radiological and Medical Sciences (KIRAMS) has performed biological dosimetry using cytogenetic assays since 2010. These assays are used for individual dose estimation in various situations, including occupational exposure, accidental radiation exposure, and health risk assessment of people living near nuclear power plants in Korea. Recent advancements in biological dose assessment methods, such as automated scoring and high-throughput assays, have improved efficiency and enabled more people to undergo dose assessment. The KIRAMS continuously explores new methods and targets for biodosimetry to enhance dose assessment capabilities and can contribute to expand the biological dose assessment capacity with the expertise and facilities, responding to large-scale accidents of radiation exposure in the world.