Radiological emergencies can vary by size and type and result from transportation accidents, nuclear power plant accidents, explosive radiological dispersal devices (RDDs/ dirty bombs), radiation exposure devices, and improvised nuclear devices (INDs). However, regardless of origin, large scale radiation emergencies, are likely to leave a sizeable group of individuals impacted by radiation exposure and/or radiation contamination. In an effort to provide immediate treatment to impacted individuals and maintain public health, neighboring jurisdictions respond by setting up community reception centers (CRCs) to conduct large-scale population monitoring operations (e.g., radiation exposure screening, contamination screening, and decontamination services). Public health agencies at the federal, state, tribal, territorial, and local levels play a significant role in implementation of these services and the overall emergency response.

Due to the critical support public health agencies provide during radiation events, NACCHO strives to ensure that local health departments (LHDs) are connected to the most up-to-date and relevant radiation preparedness resources and information. Over the course of 2016-2017, NACCHO with support from the Radiation Studies Branch at the Centers for Disease Control and Prevention (CDC), conducted a variety of research activities on data management systems for radiation population monitoring. Findings were compiled into a report, titled, “Data Management Systems for Radiation Population Monitoring,” and revealed two main takeaways. First, NACCHO discovered the use of various promising practices by a number of state and local health departments. Second, the assessment revealed key gaps in how radiation population monitoring data was collected, managed, and used, which can directly hinder response efforts during and after a radiological emergency.

Through NACCHO’s research efforts, there were many commonalities shared between LHD staff regarding how they address particular population monitoring data management issues. In response, some planning considerations were identified to address common gap areas. At this time, there are a range of systems, devices, and resources involved with the collection, management, and usage of population monitoring data during a response. Currently, when collecting population monitoring data at CRCs, many health departments first document information using paper forms, which must later be transcribed into electronic format. Some responding agencies have electronic systems in place for real-time data collection at CRCs, making it imperative that the patient data collected at each station is linked to the same individual. This is achieved by establishing connectivity over a local area network, on the cloud or through merging records by unique patient identifiers. Some jurisdictions without population monitoring data management systems have discussed potentially modifying existing disease surveillance systems to use for population monitoring data management at CRCs. State and local health departments also collaborate with other response partners. This includes organizations representing the federal government, emergency management, environmental health, the Red Cross, utility companies, and radiation control agencies, who may have existing radiation data collection systems, which could in turn be used for the management of population monitoring data.

In addition to assessing how health departments currently collect population monitoring data, NACCHO also interviewed state and local health officials to find out how this data is used in an actual response. Findings indicated an overwhelming consensus on the importance of having access to population monitoring data during the days and months that follow a radiation emergency. More specifically, personal level data collected from CRCs assists in triaging individuals through the CRC based on their level of contamination and exposure. This data can also help connect individuals to the appropriate follow-up healthcare services and to monitor the short and long-term health effects due to radiation contamination and/or exposure. In addition, aggregate level population monitoring data helps better inform public health and emergency response partner strategies. Access to aggregated data also advances on-site management by estimating overall site capacity, maintaining situational awareness, directing and requesting resources, and foreseeing project future needs. Furthermore, summarized population monitoring data can improve the decision-making process for local, regional, and state emergency response officials at the local, regional, and state levels related to directing resources, establishing evacuation zones select response sites, crafting public communications, and coordinating with healthcare and first responder agencies.

To further support local, state, and regional radiation emergency response efforts, CDC and the Federal Emergency Management Agency (FEMA) will soon release two systems, which will provide additional capabilities for population monitoring data. The first system is CDC’s CRC Epi Info Tool, which allows for the entry of population monitoring data into a database as a person moves through each station at a CRC. The second system is FEMA’s population monitoring module within RadResponder, which enables the entry of population monitoring data and aggregate CRC site data into the RadResponder application. Both of these systems are anticipated for release during summer 2017 and late 2017, respectively.

Over the next year, NACCHO will continue working with CDC, FEMA, the Conference of Radiation Control Programs Directors, and state and local partners to support the development and evaluation of new population monitoring systems. NACCHO also plans to design and promote tools helping to incorporate population monitoring data management systems into local and state emergency planning and exercises.

The full NACCHO report on Radiation Population Monitoring Data Management is available via the NACCHO Toolbox. To learn more about NACCHO’s preparedness work in the area of radiation, please visit our Medical Countermeasures and Non-Pharmaceutical Interventions webpage.

For additional population monitoring tools and resources, please visit:

• NACCHO Radiation Toolkit
• CDC Guidance: Population Monitoring in Radiation Emergencies: A Guide for State and Local Public Health Planners, Second Edition, April 2014
• CDC Video: Screening People for External Contamination: How to Use Hand-held Radiation Survey Equipment
• CDC Training Tool: Virtual Community Reception Center (vCRC)