Mass Casualty events may occur as a result of natural or human-caused disasters or after an act of terrorism. The planning and response to disasters and catastrophes needs to take into consideration the distinction between progressive and sudden events. Insidious or slowly progressive disasters produce a large number of victims but over a prolonged time period, with different peaks in the severity of patients presenting to the hospital. For example, radiation events will produce a large number of victims who will present days, weeks, months, or years after exposure, depending on the dose of radiation received. The spread of a biological agent or a pandemic will produce an extremely high number of victims who will present to hospitals during days to weeks after the initial event, depending on the agent and progression of symptoms. On the other hand, in a sudden disaster, there is an abrupt surge of victims resulting from an event such as an explosion or a chemical release. After the sarin gas attack in a Tokyo subway in 1995, a total of 5500 victims were injured and required medical attention at local hospitals immediately after the attack. The car bomb that exploded near the American Embassy in Nairobi, Kenya, killed 213 people and simultaneously produced 4044 injured patients, many requiring medical care at local hospitals. The Madrid train bombing in March 2004 produced more than 2000 injured victims in minutes, overwhelming the city’s healthcare facilities. More than 500 injured patients were treated at local hospital after the mass shooting in Las Vegas. Finally, earthquakes may produce a large number of victims in areas in which the medical facilities are partially or completely destroyed. Sudden events bring an immediate operational challenge to community healthcare systems, many of which are already operating at or above capacity. The pre-hospital as well as hospital planning and response to sudden mass casualty incidents (SMCI’s) is extremely challenging and requires a standard and protocol driven approach. Many textbooks have been published on Disaster Medicine; although they may serve as an excellent reference, they do not provide a rapid, practical approach for management of SMCI’s. The first edition of “Mass Casualty Incidents: The Nuts and Bolts of Preparedness and Response for Acute Disasters” dealt exclusively with sudden mass casualty incidents. The second edition will expand its focus and include planning and response for insidious and protracted disasters as well. This new book is designed to provide a practical and operational approach to planning, response and medical management of sudden as well as slow progressive events. The target audience of the second edition will be health care professionals and institutions, as well as allied organizations, which respond to disasters and mass casualty incidents. Parts I and II are essentially the first edition of the book and consist of planning of personnel, logistic support, transport of patients and equipment and response algorithms. These 2 parts will be revised and updated and include lessons learned from major mass shootings that occurred recently in the United States and other parts of the world Part III will describe the planning process for progressive disasters and include response algorithms and checklists. Part IV will handle humanitarian and mental health problems commonly encountered in disaster areas. Part V will deal with team work and communication both critical topics when handling catastrophes and mass casualty incidents. This new book will be a comprehensive tool for healthcare professionals and managers and should perform demonstrably better in sales and downloads. It will be of value at the pre-hospital as well as the hospital level, to plan and respond to the majority of catastrophes and mass casualty incidents.

This publication provides a practical resource for emergency planning, and fulfils, in part, functions assigned to the IAEA in the Convention on Assistance in the Case of a Nuclear Accident or Radiological Emergency. If used effectively, it will help users to develop a capability to adequately respond to a nuclear or radiological emergency.

The March 11, 2011, Great East Japan Earthquake and tsunami sparked a humanitarian disaster in northeastern Japan. They were responsible for more than 15,900 deaths and 2,600 missing persons as well as physical infrastructure damages exceeding $200 billion. The earthquake and tsunami also initiated a severe nuclear accident at the Fukushima Daiichi Nuclear Power Station. Three of the six reactors at the plant sustained severe core damage and released hydrogen and radioactive materials. Explosion of the released hydrogen damaged three reactor buildings and impeded onsite emergency response efforts. The accident prompted widespread evacuations of local populations, large economic losses, and the eventual shutdown of all nuclear power plants in Japan. "Lessons Learned from the Fukushima Nuclear Accident for Improving Safety and Security of U.S. Nuclear Plants" is a study of the Fukushima Daiichi accident. This report examines the causes of the crisis, the performance of safety systems at the plant, and the responses of its operators following the earthquake and tsunami. The report then considers the lessons that can be learned and their implications for U.S. safety and storage of spent nuclear fuel and high-level waste, commercial nuclear reactor safety and security regulations, and design improvements. "Lessons Learned" makes recommendations to improve plant systems, resources, and operator training to enable effective ad hoc responses to severe accidents. This report's recommendations to incorporate modern risk concepts into safety regulations and improve the nuclear safety culture will help the industry prepare for events that could challenge the design of plant structures and lead to a loss of critical safety functions. In providing a broad-scope, high-level examination of the accident, "Lessons Learned" is meant to complement earlier evaluations by industry and regulators. This in-depth review will be an essential resource for the nuclear power industry, policy makers, and anyone interested in the state of U.S. preparedness and response in the face of crisis situations.

The National Academies of Sciences, Engineering, and Medicine held a workshop on August 22â€"23, 2018, in Washington, DC, to explore medical and public health preparedness for a nuclear incident. The event brought together experts from government, nongovernmental organizations, academia, and the private sector to explore current assumptions behind the status of medical and public health preparedness for a nuclear incident, examine potential changes in these assumptions in light of increasing concerns about the use of nuclear warfare, and discuss challenges and opportunities for capacity building in the current threat environment. This publication summarizes the presentations and discussions from the workshop.

This Open Access volume explains how major nuclear and radiological emergencies (NREs) can have implications at local, national and international level. The response to NREs requires a competent decision-making structure, clear communication and effective information exchange. National veterinary services have the responsibility to plan, design and manage animal production system in their countries. These activities cover animal health, animal movement control, production control and improvement, and control of the products of animal origin before their placement on the market. Release of radionuclides after NREs can cause substantial contamination in the animal production systems. Critical responsibility of veterinary authorities is therefore to prevent such contamination, establish early response mechanisms to mitigate the consequences and prevent placement of contaminated products of animal origin on the market for human consumption. This work summarizes the critical technical points for effective management of NREs for national veterinary services.

Radioactive iodines are produced during the operation of nuclear power plants and during the detonation of nuclear weapons. In the event of a radiation incident, radioiodine is one of the contaminants that could be released into the environment. Exposure to radioiodine can lead to radiation injury to the thyroid, including thyroid cancer. Radiation to the thyroid from radioiodine can be limited by taking a nonradioactive iodine (stable iodine) such as potassium iodide. This book assesses strategies for the distribution and administration of potassium iodide (KI) in the event of a nuclear incident. The report says that potassium iodide pills should be available to everyone age 40 or youngerâ€"especially children and pregnant and lactating womenâ€"living near a nuclear power plant. States and municipalities should decide how to stockpile, distribute, and administer potassium iodide tablets, and federal agencies should keep a backup supply of tablets and be prepared to distribute them to affected areas.