A nuclear attack on a large U.S. city by terrorists-even with a low-yield improvised nuclear device (IND) of 10 kilotons or less-would cause a large number of deaths and severe injuries. The large number of injured from the detonation and radioactive fallout that would follow would be overwhelming for local emergency response and health care systems to rescue and treat, even assuming that these systems and their personnel were not themselves incapacitated by the event. The United States has been struggling for some time to address and plan for the threat of nuclear terrorism and other weapons of mass destruction that terrorists might obtain and use. The Department of Homeland Security recently contracted with the Institute of Medicine to hold a workshop, summarized in this volume, to assess medical preparedness for a nuclear detonation of up to 10 kilotons. This book provides a candid and sobering look at our current state of preparedness for an IND, and identifies several key areas in which we might begin to focus our national efforts in a way that will improve the overall level of preparedness.
A nuclear attack on a large U.S. city by terrorists-even with a low-yield improvised nuclear device (IND) of 10 kilotons or less-would cause a large number of deaths and severe injuries. The large number of injured from the detonation and radioactive fallout that would follow would be overwhelming for local emergency response and health care systems to rescue and treat, even assuming that these systems and their personnel were not themselves incapacitated by the event. The United States has been struggling for some time to address and plan for the threat of nuclear terrorism and other weapons of mass destruction that terrorists might obtain and use. The Department of Homeland Security recently contracted with the Institute of Medicine to hold a workshop, summarized in this volume, to assess medical preparedness for a nuclear detonation of up to 10 kilotons. This book provides a candid and sobering look at our current state of preparedness for an IND, and identifies several key areas in which we might begin to focus our national efforts in a way that will improve the overall level of preparedness.
The 2010 opening of the Captain James A. Lovell Federal Health Care Center (FHCC) created a joint entity between the Department of Defense (DoD) and the Department of Veterans Affairs (VA) that replaced two separate centers in North Chicago. VA and DoD leaders envisioned a state-of-the-art facility that would deliver health care to both DoD and VA beneficiaries from northern Illinois to southern Wisconsin, providing service members and veterans seamless access to an expanded array of medical services. Unprecedented for the military and the VA, the Lovell FHCC would integrate clinical and administrative services under a single line of authority. The DoD asked the IOM to evaluate whether the Lovell FHCC has improved health care access, quality, and cost for the DoD and the VA, compared with operating separate facilities, and to examine whether patients and health care providers are satisfied with joint VA/DoD delivery of health care. Evaluation of the Lovell Federal Health Care Center Merger: Findings, conclusions, and Recommendations finds that initial implementation of the Lovell FHCC has provided important lessons about how to integrate VA and DoD health care services and has identified remaining obstacles that the departments could overcome to make such mergers more effective and less costly to implement. The IOM recommends that the VA and the DoD develop a comprehensive evaluation plan to objectively judge its success or failure, with measurable criteria, that would provide essential knowledge for both the Lovell FHCC and future endeavors.
The Social Security Administration (SSA) uses a screening tool called the Listing of Impairments to identify claimants who are so severely impaired that they cannot work at all and thus immediately qualify for benefits. In this report, the IOM makes several recommendations for improving SSA's capacity to determine disability benefits more quickly and efficiently using the Listings.
The Metropolitan Medical Response System (MMRS) program of the U. S. Department of Health and Human Services (DHHS) provides funds to major U. S. cities to help them develop plans for coping with the health and medical consequences of a terrorist attack with chemical, biological, or radiological (CBR) agents. DHHS asked the Institute of Medicine (IOM) to assist in assessing the effectiveness of the MMRS program by developing appropriate evaluation methods, tools, and processes to assess both its own management of the program and local preparedness in the cities that have participated in the program. This book provides the managers of the MMRS program and others concerned about local capabilities to cope with CBR terrorism with three evaluation tools and a three-part assessment method. The tools are a questionnaire survey eliciting feedback about the management of the MMRS program, a table of preparedness indicators for 23 essential response capabilities, and a set of three scenarios and related questions for group discussion. The assessment method described integrates document inspection, a site visit by a team of expert peer reviewers, and observations at community exercises and drills.
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