{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T19:02:54Z","timestamp":1785351774004,"version":"3.55.0"},"reference-count":16,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Security"],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:p>The New York City Department of Health and Mental Hygiene and the Greater New York Hospital Association held 3 workshops and 2 follow-up meetings with hospital emergency managers and colleagues to determine hospitals\u2019 response actions to a scenario of a 10-kiloton improvised nuclear device detonation. The scenario incorporated 3 zones of damage (moderate, light, and beyond damage zones) and covered the period of 0 to 72 hours postdetonation divided into 3 24-hour operational periods. The Joint Commission\u2019s critical emergency areas were used to determine the objectives and response actions that would be initiated. The response actions were motivated by the resource-constrained clinical situation demanding the rationing of supplies and the application of crisis standards of care. Actions included seeking situational awareness concerning the incident and maintaining a safe and secure working environment. Due to the severance of the medical material supply chain and the levels of destruction, inner damage zone hospitals considered termination of operations and evacuation. Beyond damage zone hospitals prepared to receive patients from the inner damage zone facilities. However, these plans would not be fully successful without a significant amount of logistical aid from outside local or regional partners. Four broad planning areas with outside partners emerged from the follow-up meetings: staffing, resupply, communications\/situational awareness, and guidance. Dwindling resources will require a plan for rationing and implementing crisis standards of care and maintaining staff morale. Communications efforts need to include a formalized plan with scheduled broadcast times and identified sources of authority for hospitals to acquire and disseminate information. Information about fallout radiation, instructions for measuring contamination, and guidance for triaging and diagnosing acute radiation sickness are also needed.<\/jats:p>","DOI":"10.1089\/hs.2023.0106","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T14:13:33Z","timestamp":1734963213000},"page":"409-421","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Findings and Recommendations From a Series of Workshops on Hospital Emergency Responses to an Improvised Nuclear Device Detonation"],"prefix":"10.1177","volume":"22","author":[{"given":"Mark L.","family":"Maiello","sequence":"first","affiliation":[{"name":"Mark L. Maiello, PhD, is Radiological Projects Planning Manager, Office of Emergency Preparedness and Response \u2013 CBRN Unit; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna","family":"Mandel-Ricci","sequence":"additional","affiliation":[{"name":"Jenna Mandel-Ricci, MPA, MPH, is Chief of Staff; both at the New York City Department of Health and Mental Hygiene, Long Island City, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,12,16]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"Buddemeier B. PrepTalks Discussion Guide: Saving Lives After a Nuclear Detonation. Washington DC: Federal Emergency Management Agency; 2019. Accessed December 23 2021. https:\/\/www.fema.gov\/sites\/default\/files\/documents\/fema_preptalks_buddemeier_discussion-guide.pdf"},{"key":"e_1_3_2_3_2","unstructured":"Federal Emergency Management Agency (FEMA). Planning Guidance for a Response to a Nuclear Detonation. 3rd ed. Washington DC: FEMA; 2022. Accessed October 17 2023. https:\/\/www.fema.gov\/sites\/default\/files\/documents\/fema_nuc-detonation-planning-guide.pdf"},{"key":"e_1_3_2_4_2","volume-title":"Assessing Medical Preparedness to Respond to a Terrorist Nuclear Event: Workshop Report","author":"Institute of Medicine","year":"2009","unstructured":"Institute of Medicine. Assessing Medical Preparedness to Respond to a Terrorist Nuclear Event: Workshop Report. Washington, DC: The National Academies Press; 2009. Accessed November 4, 2024. https:\/\/doi.org\/10.17226\/12578"},{"key":"e_1_3_2_5_2","unstructured":"Federal Emergency Management Administration (FEMA). Nuclear Detonation Response Guidance: Planning for the First 72 Hours. Washington DC: FEMA; 2023. Accessed October 18 2023. https:\/\/www.fema.gov\/sites\/default\/files\/documents\/fema_oet-72-hour-nuclear-detonation-response-guidance.pdf"},{"key":"e_1_3_2_6_2","unstructured":"The Joint Commission. R3 Report. Accessed October 28 2024. https:\/\/www.jointcommission.org\/standards\/r3-report\/#sort=%40z95xz95xcontentdate%20descending"},{"key":"e_1_3_2_7_2","unstructured":"Greater New York Hospital Association. Hospital key response actions by topic. Accessed December 27 2021. https:\/\/www.gnyha.org\/wp-content\/uploads\/2020\/01\/INDResponse_Topic.pdf"},{"key":"e_1_3_2_8_2","unstructured":"Greater New York Hospital Association. Hospital key response actions by zone. Accessed October 20 2023. https:\/\/www.gnyha.org\/wp-content\/uploads\/2020\/01\/INDResponse_Zone.pdf"},{"key":"e_1_3_2_9_2","unstructured":"Greater New York Hospital Association (GNYHA). Summit: Improvised Nuclear Device (IND) Response Planning Workgroup. New York; GNYHA; 2019. Accessed July 12 2024. https:\/\/www.gnyha.org\/wp-content\/uploads\/2020\/01\/Summit_IND-Response-Planning-Workgroup_for-postingII.pdf"},{"key":"e_1_3_2_10_2","unstructured":"Maiello ML Mandel-Ricci J. Forgotten casualties: hospitals in the aftermath of a nuclear detonation. CBNW Magazine. March 26 2021. Accessed July 1 2024. https:\/\/nct-cbnw.com\/forgotten-casualties-hospitals-in-the-aftermath-of-a-nuclear-detonation\/"},{"key":"e_1_3_2_11_2","unstructured":"New York City Department of Health and Mental Hygiene Greater New York Hospital Association (GNYHA). Identified Acute Care Needs for Responding to a Detonated Improvised Nuclear Device in the New York City Region. New York: GNYHA; 2019. Accessed December 27 2021. https:\/\/www.gnyha.org\/wp-content\/uploads\/2020\/01\/State-Federal-Requests_Overview-Document.pdf"},{"key":"e_1_3_2_12_2","unstructured":"Radiation Emergency Medical Management. Radiation triage treat and transport system (RTR) after a nuclear detonation: venues for the medical response. Updated June 24 2024. Accessed July 8 2024. https:\/\/remm.hhs.gov\/RTR.htm"},{"key":"e_1_3_2_13_2","unstructured":"Federal Emergency Management Administration. Integrated Public Alert & Warning System. Updated April 22 2024. Accessed July 8 2024. https:\/\/www.fema.gov\/emergency-managers\/practitioners\/integrated-public-alert-warning-system"},{"key":"e_1_3_2_14_2","unstructured":"Radiation Emergency Medical Management. Accessed March 1 2022. https:\/\/remm.hhs.gov\/"},{"key":"e_1_3_2_15_2","volume-title":"Crisis standards of care: an overview","author":"Hashmi S","year":"2024","unstructured":"Hashmi S. Crisis standards of care: an overview. Remarks presented at: New York City Department of Health and Mental Hygiene\u2019s Pipeline to Preparedness Fellowship Graduation; February 29, 2024; New York, NY."},{"key":"e_1_3_2_16_2","unstructured":"Administration for Strategic Preparedness and Response (ASPR) Technical Resources Assistance Center and Information Exchange (TRACIE). Medical Operations Coordination Centers (MOCC)\/patient load balancing: summary of lessons learned during COVID-19. Published May 2022. Accessed October 25 2024. https:\/\/files.asprtracie.hhs.gov\/documents\/mocc-patient-load-balancing-summary-of-lessons-learned-during-covid-19.pdf"},{"key":"e_1_3_2_17_2","doi-asserted-by":"crossref","unstructured":"Bell DL Katz MH. Modernize medical licensing and credentialling too\u2014lessons from the COVID-19 pandemic. JAMA Intern Med. 2021; 181(3):312\u2013315.","DOI":"10.1001\/jamainternmed.2020.8705"}],"container-title":["Health Security"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/hs.2023.0106","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/hs.2023.0106","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/hs.2023.0106","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T08:41:25Z","timestamp":1777452085000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/hs.2023.0106"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,1]]},"references-count":16,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,12,1]]}},"alternative-id":["10.1089\/hs.2023.0106"],"URL":"https:\/\/doi.org\/10.1089\/hs.2023.0106","relation":{},"ISSN":["2326-5094","2326-5108"],"issn-type":[{"value":"2326-5094","type":"print"},{"value":"2326-5108","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,1]]}}}