RSB Product and STLT Preparedness Assessment

Attachment E-Instrument MS Word Form approved

OMB No. 0920-0879

Expiration date: 03/31/2018

Welcome to the Centers for Disease Control and Prevention’s (CDC) assessment on radiation emergency preparedness.

You have been asked to take part in an assessment as a government official involved in planning for the public health response to a radiological or nuclear incident. The purpose of this assessment is to gather information about the current level of radiation emergency preparedness among state, territorial, tribal, and local governments. In addition, CDC would like to receive feedback about some of their CDC Radiation Studies Branch (RSB) products.

This assessment should take about 20 minutes to complete. You may stop taking the assessment and finish it at a later time. However, you must continue taking the assessment on the same computer or mobile device on which you started taking the assessment. Please do not take this assessment on a mobile device while you are driving.

You may want to have a copy of your radiation emergency response plan or radiation-specific annex to your all-hazards emergency response plan available for reference. Even if your department or agency does not have a radiation emergency response plan or radiation-specific annex to an all-hazards emergency response plan, please continue to take the assessment.

Please complete the assessment by [INSERT DATE]

It is your choice to complete the assessment. You may choose not to answer any question for any reason. You can stop taking the assessment at any time. No individually identifiable information will be requested.

Your input will help the CDC Radiation Studies Branch to provide the most needed and useful content in radiation emergency planning materials.

If you have any technical issues, please contact Jennifer Hendricks at (865) 241-1326 between 8:30 am–5:00 pm (EST).

If you have questions about your rights as a participant, you can contact the Oak Ridge Site-Wide Institutional Review Board, Oak Ridge Institute for Science and Education, Oak Ridge, TN 37831-0117, 865-574-4359, [email protected].

Please choose one option below to continue:

• I agree to participate in the assessment and I am at least 18 years old.

• I do not want to participate in the assessment.

Section 1

1. Is planning for radiological and nuclear incidents a part of your job responsibilities?

   • Yes

   • No (THANK AND EXIT ASSESSMENT)

2. What level of government best describes your employer?

• State agency

• Territorial agency

• Tribal agency

• Local agency

• None of the above (THANK AND EXIT ASSESSMENT)

3. What occupational specialty best describes your role within your agency?

• Public Health Preparedness

• Radiation Control

• Emergency Management

• None of the above (THANK AND EXIT ASSESSMENT)

4. How many years have you worked in radiological and nuclear planning?

• 0-5 years

• 5-10 years

• 10-15 years

• 15+ years

5. Does your jurisdiction include a nuclear power plant or is it within the 10-mile emergency planning zone for a nuclear power plant?

   • Yes (GO TO Q6)

   • No (GO TO SECTION 2 Q7)

6. Does your department/agency participate in the Radiological Emergency Preparedness (REP) program for a nuclear power plant?

   • Yes, I personally participate in REP planning

   • Yes, someone in my department/agency participates in REP planning

   • No, my department/agency does not participate in REP planning

(ANY ANSWER, CONTINUE TO SECTION 2)

Section 2

7. What should be the priorities of public health departments in a radiation emergency? (select all that apply)

• Provide information to the public

• Support mass care operations

• Support medical operations

• Conduct environmental health monitoring

• Conduct epidemiological surveillance

• Coordinate screening and decontamination operations

• Distribute medical countermeasures (if needed)

• Other:

8. What are your expectations of CDC in supporting health departments during radiation emergency preparedness and response activities? (select all that apply)

• Provide guidance

• Provide technical consultation

• Provide training

• Provide risk communication messages

• Coordinate information sharing among partners

• Support screening and decontamination operations

• Support epidemiological surveillance

• Support medical operations

• Support mass care operations

• Support environmental health monitoring

• Deliver medical countermeasures (if needed)

• Other:

9. Do you have a radiation emergency response plan or radiation-specific annex to your all-hazards plan that addresses public health responsibilities?

• YES (GO TO Q12)

• NO (GO TO Q10)

10. Are you in the process of completing a radiation emergency response plan or radiation-specific annex to your all-hazards plan that addresses public health responsibilities?

• YES (GO TO Q12)

• NO (GO TO Q11)

11. What factors have impeded the development of your radiation response plan? (Select all that apply)

• Low risk on hazard vulnerability assessment (HVA)/jurisdictional risk assessment (JRA)

• Limited funding to build radiation response capabilities

• Limited staff to mount a radiation response

• Limited instrumentation to mount a radiation response

• Other:

(ANY ANSWER, GO TO SECTION 3, Q22)

12. Does your radiation response plan or annex address the following population monitoring considerations:

ITEM	YES	NO	DON’T KNOW
Identifying the impacted population
Setting up community reception centers (CRC)
Staffing CRCs
Establishing contamination screening protocol
Establishing decontamination protocol
Conducting internal contamination assessments
Creating a registry for public health follow-up
Providing counseling/mental health services
COMMENTS:

13. Does your radiation response plan or annex address the following public health and medical considerations:

ITEM	YES	NO	DON’T KNOW
Managing medical treatment of radiation causalities
Distributing medical countermeasures
Identifying vulnerable populations
Coordinating mortuary services for mass fatalities
COMMENTS:

14. Does your radiation response plan or annex address the following worker health and safety considerations:

ITEM	YES	NO	DON’T KNOW
Establishing radiation control zones for responders
Providing personal protective equipment (PPE) recommendations
Establishing a worker dosimetry program
COMMENTS:

15. Does your radiation response plan or annex address the following shelter considerations:

ITEM	YES	NO	DON’T KNOW
Establishing public shelters in radiation emergencies
Supporting radiation monitoring in public shelters
Monitoring shelter residents for health issues
COMMENTS:

16. Does your radiation response plan or annex address the following laboratory considerations:

ITEM	YES	NO	DON’T KNOW
Prioritizing people for biological sampling (i.e. blood and urine samples)
Coordinating (i.e. collecting, packing, shipping) biological sampling
Coordinating environmental sampling ( i.e. air, soil, water, and crop samples)
COMMENTS:

17. Does your radiation response plan or annex address the following risk communication considerations:

ITEM	YES	NO	DON’T KNOW
Issuing protective action recommendations for the public
Developing health messages for the public
Communicating radiation risk to the public
COMMENTS:

18. Who did your department/agency engage in your planning? (select all that apply)

• Political Leaders/Policy makers

• State Public Health Agency

• Local Public Health Agency

• State Radiation Control Authority

• Local Radiation Control Authority

• State Emergency Management Agency

• Local Emergency Management Agency

• Shelter Planners

• School Officials/Planners

• Nongovernmental Organizations (NGOs)

• Volunteers

• Hospital Planners

• Clinicians

• I did not engage with other partners

• Other:

19. Which funding sources did you use to develop the plan? (select all that apply)

• CDC Public Health Emergency Preparedness (PHEP) Grant

• HHS Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program (HPP) Grant

• State funded

• Other:

20. Did you use a template to help you develop the plan?

• YES (GO TO Q21)

• NO (GO TO SECTION 3 Q22)

21. What template(s) did you use to help develop the plan?

• National Association of County & City Health Officials’ (NACCHO’s) Public Health Radiological Response Annex Template

• Radiation plan from another jurisdiction

• Modified one of your existing plans

• Other:

(ANY ANSWER, CONTINUE TO SECTION 3)

Section 3

22. Have you used any educational materials, planning aids, training products, or guides about radiation emergency response from CDC?

• Yes

• No (GO TO Q26)

23. How would you rate the usefulness of the following CDC products:

ITEM	Very Good	Good	Fair	Poor	Very Poor	I have heard of it , but did not use the product	Not familiar with the product
Radiological Terrorism: Tool Kit for Public Health Officials
Radiological Terrorism: Tool Kit for Emergency Services Clinicians

24. How would you rate the usefulness of the following CDC planning tools for radiation emergencies:

ITEM	Very Good	Good	Fair	Poor	Very Poor	I have heard of it , but did not use the product	Not familiar with the product
Population Monitoring Guide (Guide Book)
Virtual Community Reception Center (vCRC) (Online Training)
Guidelines for Handling Decedents Contaminated with Radioactive Materials (Guide Book)
Radiological/Nuclear Law Enforcement and Public Health Investigation Handbook (Guide Book)
Public Health Planning for Radiological & Nuclear Terrorism (Video)

25. How would you rate the usefulness of the following CDC training tools for radiation emergencies:

ITEM	Very Good	Good	Fair	Poor	Very Poor	I have heard of it , but did not use the product	Not familiar with the product
Psychological First Aid in Radiation Disasters (Online Training)
CRC Operations in Radiation Emergencies (Video)
Virtual Community Reception Center (vCRC) (Online Training)
Radiation Basics Made Simple (Online Training)
Screening People for External Contamination (Video)
Medical Response to Nuclear and Radiological Terrorism (Video)
Radiological Terrorism: Just-in-Time Training for Hospital Clinicians (Video)
Training for Handling Decedents Contaminated with Radioactive Materials (Video)

26. What training topics would be of interest to you: (SELECT ALL THAT APPLY)

Radiation Dose Measurement Radiation Safety Principles Personal Protective Equipment in Radiation Emergencies Data Sharing in Radiation Emergencies Risk Communication in Radiation Emergencies Health Effects of Radiation Health Care Facility Radiation Preparedness Non-Pharmaceutical Management of Radiation Health Effects Pharmaceutical Management of Radiation Health Effects (Countermeasures) Psychological First Aid in Radiation Emergencies

Community Reception Centers Epidemiology in Radiation Emergencies Laboratory Response to Radiation Emergencies Role of Public Health in Radiation Emergencies Community Radiation Preparedness Developing a Radiation Response Workforce Fatality Management in Radiation Emergencies Federal Radiation Resources Shelter Operations in Radiation Emergencies Legal Considerations in Radiation Emergencies Working with Law Enforcement in Radiation Emergencies Others:___________________________________

27. From what professional organizations would you prefer to receive information about radiation emergency preparedness? (select all that apply)   

• NACCHO (National Association of County and City Health Officials)

• ASTHO (Association of State and Territorial Health Officials)

• NARR (National Alliance for Radiation Readiness)

• CRCPD (Conference of Radiation Control Program Directors, Inc.)

• NEMA (National Emergency Management Association)

• IAEM (International Association of Emergency Managers)

• Other:

28. From what government agencies would you prefer to receive information about radiation emergency preparedness? (select all that apply)

• CDC (Centers for Disease Control and Prevention)

• FDA (Food and Drug Administration)

• EPA (Environmental Protection Agency)

• DOE (Department of Energy)

• DHS/FEMA (Department of Homeland Security/Federal Emergency Management Agency)

• USDA (U.S. Department of Agriculture)

• Other:

29. What methods do you prefer for receiving information about radiation emergency preparedness?  (select all that apply)

• Professional Conferences

• Websites

• Social Media (e.g., Facebook, Twitter)

• Webinars

• Podcasts

• Direct Mailings

• Newsletters

• Listservs

• Other:

30. Please leave any additional comments or suggestions that could help CDC better support radiation preparedness efforts.

Public reporting burden of this collection of information is estimated 20 minutes to complete this assessment, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879)