ML20247G961

Intervenor Exhibit I-MAG-78,consisting of Commonwealth of Ma Testimony of J Leaning on Resource Needs of Radiologically Injured,Dtd Feb 1989

ML20247G961
Person / Time
Site:	Seabrook
Issue date:	04/19/1989
From:	Leaning J MASSACHUSETTS, COMMONWEALTH OF
To:
References
OL-I-MAG-078, OL-I-MAG-78, NUDOCS 8905310123
Download: ML20247G961 (37)

Text

{{#Wiki_filter:_ / y (4 DOLHEIED USNBC-UNITED STATES OF AMERICA . NUCLEAR REGULATORY COMMISSION' 89 liAY 23 P3:56 ' ATOMIC' SAFETY AND LICENSING BOARD _pp.p.: .., +, 'jb(I f IIl I Before Administrative Judges: Ivan W. Smith, Chairperson Richard F.' Cole Kenneth A. McCollom i r ~ ) N In.the Matter of ) Docket Nos. ) 50-443-OL PUBLIC SERVICE COMPANY OF ) 50-444-OL LNEW HAMPSHIRE, ET AL. ) (OFF-Site EP) (Seabrook Station, Units.1 and 2 ) ) COMMONWEALTH OF MASSACHUSETTS TESTIMONY OF DR.'JENNIFER LEANING ON THE RESOURCE NEEDS OF THE RADIOLOGICALLY INJURED NUCLEAR REGUI.ATORY COMMISSION. DodelNo. @3 1%Ata3 O{ o..__ Of.ki?! Exh No. W in una mder of bbkhtiiCD fn cK_f_/g[bjQmjaskrQ MS" m e:r:n w _ S t 3,c o _ AEP'iant _ g ;g,3 y d-.-~._.C:lCGo ._JQQ "' W a}:: 0:n __._._ _._ r Cd'U OCIOT 31Qt.n D g,_ D3,7,2 gf OWu __ _,yj,, m,_ wu o v 8905310123 890419 PDR ADOCK 05000443 0 PDR mL '78 i _z_--____--_----_--_-____-_---

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SUMMARY

OF THE TESTIMONY: I-t

Dr.-Jennifer Leaning will

testify:as an expert witness on-

the resource needs'that are required by the radiologically.

injured.. She will opine on'that. medical resourcesLare needed ?! for personstwho'are. radiologically injured'in various degrees. o i In connection with other testimony-being. submitted, this ' testimony is' offered.to establish under JI Contention 46, that the'.SpMC fails'to provide adequate support and assistance to ~ the radiologically' injured. M A statement:of.Dr.LLeaning's professional credentials was previously! submitted in this proceeding in a piece of testimony-

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by'her on the' health effects of radiation = doses dated' s 1 . September 14,.1987 on pages.9-10. A-detailed resume is attached. f . j i l l- _________._____.____.______m_

'i... i + j l 3 I i J. Leaning, M.D. February, 1989 ) EMERGENCY MEDICAL RESPONSE TO A MAJOR ACCIDENT AT SEABROOK: MEDICAL NEEDS AND RESOURCES The key issues involved in organizing an emergency medical response to a major accident at Seabrook include: I.

1) Estimation of probable ranges of radiation releases

2) Estimation of number of people at risk of exposure for a given radiation dose

3) Development of a process for identifying and categorizing people according to their level of exposure

4) Specification of the level of medical response that will be needed for each category of person exposed i

5) Establishment of a system to provide the resources needed to deliver that requisite level of medical response i

F:n, 4 ,.-{ 4 The focus of this statement is on these last two tasks. The approach proposed below is aimed at addressing' the two-problems-embedded in-the structure of the disaster.under discussion: ' the problem of scope and the problem of ' radiation exposure. L 1)The Problem of Scope: . The parameters of the scenario are of necessity very-uncertain and any emergency medical response plan must be ' adequate to encompass a great range in the numbers of people who will need to be screened and incorporated into a health care - system. 2)The Problem of Radiation Exposure: The response plan must define a system that is capable of i - identifying those at risk of

exposure, minimizing ongoing exposure, registering and treating those who have been exposed, 1

and creating a record system suitable for long-term epidemiologic tracking and follow-up. l { Specification of the level of medical resoonse that will l be needed for each catecorv of eerson exoosed: l J

\\ ( 7 ,-1 5 overview: All people. in the pathways of exposure must be identified and. records kept of key baseline medical and demographic data, i' .All those whose radiation e:tposure levels require decontamination or other interventions must be directed to designated sites for this care. All people with mixed injuries. (radiation and other injuries resulting from the accinent) must be identified and sent to hospitals located outside the exposure pathway that have been specially prepared.in advance for the reception and treatment of such patients. Records of all people who have been exposed and/or injured must.be. maintained in a central data base which can serve as the I information source for accurate and comprehensive long-tern. follow-up. Medical Triage: Those whose history of symptoms and travel routes indicate a risk of moderate or substantial exposure to radiation must, after l, decontamination, be examined by medical personnel who, on the basis of a more detailed history and physical, will decide whether to' send a person to a general hospital (for patients with moderate exposure) or to a referral hospital for patients with

4? s I 6 more' serious exposures. The medical personnel must be in communication with the receiving ' hospitals, in order to coordinate. patient flow. Vans may take the less seriously exposed to their assigned hospitals; ambulances, if necessary, will take those with more serious - exposures to their destinations. As the regional and state l i referral centers for the severely exposed become full, it may be .necessary to transport these patients by helicopter and/or fixed wing aircraft to the out-of-state hospitals to which they have been referred. Prior to transfer, each of these patients must be registered and particular notice made of their destination and the next'of kin-who will need to be notifed of their whereabouts. Treatment Categories Based on Estimated Exposure Range: 1)O to 25 rads: No medical treatrent needed. Registration of all people in i this category will still be required, however, in order to ensure that they are included in the population cohort slated for follow-up. (This follow-up, necessary for the entira exposed population, must consist of medical and epidemiologic surveillance over a period of at least two generations.) L _ ______

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a L Since ' individual response to a givenL estimated radiation exposure Lis known.to be variable,- 'it is possible that ' within several hours 'of : exposure a very.small percentage ~ of. people-exposed. at? this dose range L may become symptomatic '(nauseated, vomiting) and seek medica care.-.At triage sites they will'be. difficult. to ' distinguish.from people who have suffered. more serious exposures'and.thus they may enter the medical care system . and. consume resources for "e duration of their - symptomatic.

pyriod (probably not more than a few days).

j.. 2)25 to 150 rads: Approximately 50' percent of people' exposed in. this dose range.. will L exhibit symptoms of nausea and vomiting.. They. will evincethe same symptoms.as people in higher ' dose range categories.and can be distinguished from people with more serious exposures only-on the basis of laboratory tests and their clinical course during the succeeding two ' to three-day period. These people will require admission to a general medical-surgical ' ward of a community hospital.. Services needed will include daily blood. tests (to follow the course of cells in the peripheral blood); intravenous fluids (if nausea and vomiting are sufficient to-lead to mild or moderate dehydration); and collection of urine and feces to screen for internal contamination. The laboratory facilities must be capable of safe collection of materials that L_ -_= _

l b 8 are potentially contaminated with radioactivity. (The materials could be sent.to an off-site laboratory for actual assay but the transport time should be minimal.) 3)150 to 300 rads: All people in this exposure range can be expected to experience nausea and vomiting. The majority of people in_this category will progress to more severe illness characterized by the hematopoatic syndrome (steep decline in white blood cells and . platelets, susceptibility to infection, loss of peripheral red blood cells). The course of this illness takes at.least 3 weeks to evolve and then recovery, given adequate support, can be expected for the majority. However, perhaps 10 percent of the peopple in this dose range category may die from infection or from hemorrhage. All people assessed to be in this exposure range will need to be hospitalized in a tertiary care setting, with access to intensive care services and high technology interventions, including extensive antibiotic administration, meticulous fluid infusions, reverse isolation techniques. If substantial internal contamination has

occurred, experimental therapies may be attempted (pulmonary

lavage, gastro-intestinal lavage and chelation).

,I 't 4. k ': pl g. e '4)300'to'600 rads: H v;9

Psople. ~ in this- ' exposure. category. Sill-all : require L

hospitalization in a. tertiary care setting. and the full panoply of - interventions described for people in category. 3) above.- In ' addition,- - because - 'of. the severity of bone marrow suppression caused' by' doses in this range, bone marrow transplant may be. ,j attempted. (In the'13 chernobyl patients in whom this procedure j. 'was' attempted, 12 died; the one survivor may have been' supported by the' bone marrow transplanc but his recovery occurred when'his Y own bone marrow regenerated.) ) f The. distinguishing feature of people in. this-exposure L. category is their much higher projected mortality (at least'50 percent) and the long duration of stay they will require' (3 to 6 months ' ' acute care hospitalization, during which - death may be l forestalled by medical intervention but not necessarily Lprevented). 5)Over 600 rads: b Vi'nually all people in this exposure range can be expected -to die. Their deaths may well occur after protracted hospitalization and extensive treatment, spanning a period of 3 to 6 months. During this time they will occupy intensive care beds and consume a large share of medical and social resources. L L' 1: 1 \\ l

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'i i 10 Allocation Decisions: Plans to consume scarce resources will provoke allocation questions. In particular, such resources include inpatient iv:ensive care medical beds and blood products. In some disaster settings, where needs overwhelm resources available in the time frame required to save lives, allocation decisions will also dictate the level of medical response that can be provided. Only a ~more austere, attenuated range of options might be possible. In the setting of a severe nuclear power plant accident in the U.S., : however, the number of casualties expected from even a worst-case.- scenario would probably not overwhelm the total national resources available. There are approximately 2000 intensive care-burn beds in the country and approximately beds with intensive care capacities. The allocation issues in the U.S. would' revolve around transfer questions, since these existing intensive care unit beds are scattered throughout the nation and are, in the course of normal operations, characterized by high occupancy rates. 1 i These allocation issues would play out at the local level, where the lack of open intensive care unit beds would require the 1 transfer of some patients to other areas, possibly out of state. l The challenge then would be to coordinate that national response with sufficient precision so that no patient is harmed in the

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allocation and transfer process. { lu i l, ' . Initial. discussion will'arise over the question of who. takes l b precedence:.on what grounds, medical or. ethical, can a bed or blood ! products be given-to a' victim of radiation exposure Las opposed to a, patient with leukemia?- Who'makes these decisions-- or, more relevant--who decides who will be. given the power to make these ' decisions? The. local' physician caring.for' the leukemia ' patient will resist the transfer of his patient; the surgeon following a young patient' in the ICU, recovering from extensive surgery after a serious automobile accident will also l - insist-that his. charge requires the bed he currently. occupies. - Hospital administrators and chiefs of staff will be loathe 'to intervene. The medical resources required at the receiving : hospitals - will be extensive. Careful advance planning.will-be needed in order to define the philosophy and protocol to 'ba followed for the following allocation decisions: --what patients to transfer from inpatient' beds needed for i the care of patients exposed to radiation; --where these transferred patients should be transferred to; --use of blood products; --assignment of skilled personnel; --diversion of patients not associated with the emergency i -m..m.__ .-._._____m.

t :o r .j ij l 12 who, require admission and treatment at a referral j ) hospital;. l --reimbursement for hospital and staff services, supplies, .{ and equipment. To settle these complex and intimate medical and administrative decisions. will require a planning process that begins far in advance of the event and extends throughout very decentralized and. traditionally autonomous sets of cAvilian . health care institutions. An intensive educational campaign directed at families and the local communities involved would also be necessary,.to minimize the conflicts and anger'that will inevitably arise.when individual inpatients are selected for transfer to another, more distant facility, d Establishment of a system to orovide the resources need to deliver the reauisite level of medical resoonse: i l To support a medical response of this magnitude requires both a. medical and logistic organization and a medical resource base. Medical and Logistic organization:

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L n 13 Medical personnel will need to be organized into three echelons. of care. The first echelon must be located at the l initial triage site to which people will have been told to evacuate, by car or on foot. These triage sites will need to be located outside the exposure sector. At these sites, trained personnel will screen the population for radiation exposure, initiate the data base on all people at

risk, perform decontamination procedures on all people for whom this intervention is necessary, and refer to higher sites of care all people who require it.

The referral sites are designated hospitals throughout the state as well as the nation which have the capacity to care for people with radiation exposure. People transported to these sites will need to travel either by ambulance or air transport, as necessary. i Within the state, in areas adjacent to the accident site but outside the exposure

path, designated hospitals will be responsible for receiving and caring for those patients who have suffered mixed radiation and other physicial injury.

Patients will need to travel to these sites via ambulance, f All medical personnel involved in delivering this emergency i care must be be trained in how to perform their roles and drills j t j must be held periodically to ensure that response is maintained I L

] l 14 at a high level of. competence. Lines of authority and communication between and among referral sites must be e s t a b l i s h e r. i n advance and must be practiced in all emergency response drills. Organizational links to the regional, state, and federal incident commands must be established and integrated into the overall plan for training and emergency drills. Logistic support _frem

area, state, and national emergency transport systems must be built into this response.

The need for such communication networks and organizational links arises from the difference between the routine function of the health care system and the way it must function in a mass casualty mode. . Routine operations do not require an extensive communications network among health care institutions or separate geographical sites. Most of health care activities take place -l within one institution or site of care. Referrals of patients l for transfer, whether to compensate for lack of beds or to secure a speciality. service, are relatively infrequent. Even occurring at low volume, ' however, it is well known that such patient transfers are often accompanied by communications mishaps which create small or large tensions between referring and receiving sites. l In the setting of a major emergency with hundreds and \\ l perhaps thousands of people requiring referral and transport to secure specialty services, it is essential to have established a ( ) 1

i 15 system that' allows providers at the first echelon to communicate up the line and that allows referral centers to relay back when H their beds are full or resources expended. These systems must be-l established in advance, so that in the event of the disaster, the communications loops have been defined patients are not sent inadvertently to sites where they cannot be accommodated. Close attention to the design of these systems, in terms of the administrative, psychological, and technical aspects, will mark the difference between success and failure. Any mass casualty referral plan must confront head-on the problem of interface among a wide range of professionals. Interface has several elements: turf issues, communications styles, authority patterns, overlap or gaps in responsibility and role definitions. Each group of responders enlisted in this plan will-rely on customary interactions among themselves and with the limited range of other groups they usually engage in the course of their daily ' work. An emergency response plan re-assembles people into different relationships. The requirements of these different relationships, and the problems they pose in adjustment, must be addressed and resolved in advance. I Resource Requirements: i I The resources required to support this response include l l

q [. .1 l 16 those that' exist but must be redeployed in new organizational roles on an emergency basis and those that must be created in advance and rapidly employed at the time of the accident. I In.the first category are the hospital-based systems: local and referral. Both categories of hospital must be prepared in i advance to. mobilize to receive emergency radiation patients on very short notice. Such preparations include plans for rapid discharge and/or reassignment of current inpatients. Also,in the first category are the large numbers of medical ~ personnel required to staff the initial triage sites and then, [ over-weeks to

months, care for those who remain ill-from radiation effects.

Manpower needs will have to be squeezed from the existing pool of health care workers 'who are already I currently employed and in short supply throughout the nation. In the event of an accident, some of these health care workers wil? 3 have to be reassigned, at least on an interim basis. Coverage arrangements would best be made in advance, to minimize effects on patient care. Depending upon patient volume, emergency patient transport requirements may also be met by pre-existing resources. The emergency medical system will be relied upon to transport patients to designated community and near-by referral hospitals. The civilian emergency air transport system may have to be

~ ~ ,y e 17 responsible. for_ moving patients to radiation referral sites around I the. country. If the numbers requiring interstate transport are large, the resources.of the Air National Guard.may .have to be> employed. . Resources that must be created in advance.and used only.in. the event ' of an accident are all the ' consumable supplies and i i mobile shelter-equipment needed for decontamination on a population scale. Resources that might be dispersed'andfused i l for-other purposes but must be immediately availab1e for-dedicated use duri'ng the emergency include all mobile vans needed for the transport of medical personnel and the general public, the computerized. data system, all cellular phones required 'for the medical' communications system, and dedicated emergency phone lines, both fixed and cellular. Everyone involved in supporting the emergency response-will expect, in some way, to be reimbursed for his services. That I expectation will become evident in the planning process and must be managed in a straightforward manner. Certain kinds of goods and services are the responsibility of local, state or federal . government to furnish and pay for; others are provided by the private sector. Ultimately, many of the reimbursement issues may land in the courts or be without dispute considered the responsibility of the utility. Nothing will cloud or interfer with the planning process more than lack of clarity on this I x_

w m ? *i l ( l l. '18 question. l I Marshalling these necessary resources is a time-consuming ~ and costly task, in both the planning phase and in the case.of an accident. The task requires a sophisticated and robust planning structure, capable of enlisting all the major players (emergency responders, transport and communications personnel, medical personnel, hospitals throughout the state and the country, third-party ' payors) in an ongoing and concerted planning effort. This structure must also be capable of setting in motion the command and communications systems that will be needed to carry out whatever actual response may be dictated by events.

== Conclusion:== The emergency medical response to a disaster-of the magnitude possible in a serious nuclear power plant accident can be

planned, developed, and established only through the coordinated efforts of many private and public institutions and t

agencias throughout the nation. Without careful, thorough, and comprehensive preparedness planning, the medical response that can be expected in the event of a major nuclear accident will be haphazard, disorganized, and inadequate to meet the needs of the people exposed and the society at large.

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w..

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and Ricks, R.C., " Emergency - Department Radiation. . Accident ' Protocol," Annals of Emercancy Medicine 9 (1980): 462-470. Linnemann,. R. E.,- . Soviet Medical. Response to the Chernobyl Nuclear. Acdident," Journal of the American Medical Association 258-(1987):' 637-43. -Lushbaugh, C.C., " Human Radiation Tolerance," in Space Radiation Bioloav and-Related

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and Nigg, J.M., " Emergency Preparedness and Response Planning: An Intergovernmental Perspective," in. Lystad, ed., 1988, pp. 346-370. l

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(g. a t-23

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4 + a b' j cuRRICJ4]M VME l b + Name: 'Jennifer I.eaning (Link) i Address:L '- RFD 4,113 'Ibwer Road,- Lincoln, MA 01773 Telephone: 617-259-9108 (Hane)- J 7 Place'of Birth: San Francisco, California 1 Education: I .1968 A.B. Radcliffe College -1970 M.S. Harvard School of Public Health 1975 M.D. University of Q11cago Pritzker School of Medicine Predoctoral Work Experience: 1965-1966 Maternal and child health care, Tanzania, East Africa ' Predoctoral Research Experience:' 1963-1968 Research assistant to Barbara M.. Solomon, (then Dean at Radcliffe): History of American Wanen Paemarch assistant at' the Center for Studies in Education and Development:~ annotated bibliography of African education Faculty aide at Women's Archieves, (now the Schlesinger Library): dating and annotatinJ. letters of women suffrage. activists '.968 Summer Assistant to.the Director;. Population Service, Agency for International Development: developed three-demonsional graph for population growth analysis; supervisor R. Ravenholt,.M.D. 1969 Summer Field researcher and data analyst for A.I.D. population' study in rural Taiwan:~' tested and revised interview instrument and wrote training manual.to instruct field workers in the'use of the revised interview;'su mrvisor Dr. David Heer, Harvard School e of Public Health l-1970-1971 Associate Director of Mid-Southside Health Planning organization, Oticago, Illinois: wrote several a=amamments of health care needs of population of southside 011cago; principal author of swm==ful ( grant proposal to Office of Econtanic Opportunity for establishment of four neighborhood health centers in that area 1972-1973 Data analyst for hypertension program using castputer protocol for drug treatment; supervisor, j Frederic Coe, M.D., Michael Reese Hospital

1 , Postdoctoral Traini!q Internship and Residencies: 1975-1976 Intern in Medicine, Massachusetts General Hospital 1976-1977 Resident in Medicine, MassadTJsetts General Hospital 1977-1978-Clinical Fellow in Medicine, Massachusetts General Hospital . Licensure arxi certification: 1976 Diplomate, National Board Of Medical Examiners 1977 Massachusetts License Registration 1978 Diplcanate, American Board of Internal Medicine 1980 Instructor Certification, Advanced Cardiac Life Support i 1983 Certification, Provider, Advanced Trauma Life 1 Support l 1984 Diplcunate, American Board of Emergency Medicine i 1986-1988 Re-certification, Provider, Advanced Cardiac Life Support Re-certification, Instructor, Advanced Cardiac Life support i Academic Appointments: l 1975-1378 Clinical Fellow in Medicine, Harvard Medical l School 1978-1982, 1983-1984 Clinical Instructor In Medicine, Harvard Medical School k 1986-Instructor in Medicine, Harvart; Medical School 1983-1985 Researdt Affiliate, Iaboratory of Architectural Sciences and Planning, Massachusetts Institute of Todinology 1983-1984 Scholar-in-residence, Radcliffe' College I 1984-Visitirg Scholar, Radcliffe Cellage 1986-1988 Researdi Associate, Institute for Health Research, Harvard University Hospital Appointments: 1975-1978 Assistant in Medicine, Massachusetts General Hospital I 1978-1982, 1983-1984 Attending Physician, Department of Medicine, Mount Auburn Hospital 1 1982-1983 Atteniiry Physician, Newton-Wellesley Hospital Attending Physician, Carney Hospital f 1984-1986 Attending Ihysician, Harvard Ccamunity Health l Plan Hospital i 1986-Attending Physician, Brigham & Wcxnen's Hospital i _ = _ _ o

^* - 1 l a .' l t -a Awards'and' Honors: .1968 .A.B. magna cum laude Captain Jonathan Fay Prize Senior Sixteen mi Beta l<appa 1970 Briggs Fellowahip, Radcliffe College 1975' M.D. with honors-Upjohn Award Alpha Cmaga Alpha Major Committee Assignments: Hospital: l 1979-1981 Infectious Diamama Ccannittee, Mount Auburn Hospital c

1983-1984 Joint Conference Cenetittee, Mount Auburn Hospital i

1985-1986 HCHP-H Medical Executive Oczanittee -1986-1987' - Patient Care n=1ttee, Brigham & Wcanan's Hospital and Harvard &=artity Health Plan Memberships,. Offices a' nd Carmnittee Assigranents in Professional Societies:. 1979-Physicians for Social Responsibility Descutive'Ctzunittee and Board of Directors 1979-1984 (diair frtan 1979-1981 Secretary 1983-1984 Treasurer 1984)' Acting Medical Director 1982 Icng Range Planning Group 1984-(diair 1984-1986) Board of Dir.Tu.u.., ' 1987- '1981-' American College of EE-pJf mysicians -1982 - American'Public Health Association 1985-Co-chair, Governor's Advisory Committee on the j Impact of the Nuclear Arns Race on j Massactiusetts -1 1985-1987 diair, Rapid Response Fund Ccannittee, Medical' l Advisory Task Force, U.S.A. for Africa l 1985-Member, Arms Control Advisory Ccannittee to ] Senator ~ John' Ferry 1987-Consultant to the Ctzunonwealth of Massachusetts on Emm.p cf Medical Planning for the' Seabrook Nuclear Power Plant l' 1987-Consultant to the Three Mile Island Public ) Health Advisory Fund on Emergency Medical l Planning for the 'Ihree Mile Island Nuclear j Power Plant l

- _ _ _ _ _ = _ _ _ _ _ - _ ___ bm Tt I 4.' g Teaching Experience: 1977-1978 Organizer of three two innek courses on Emergency Medicine at Massa & usetts General Hospital 1977-1978 Iacturer en respiratory' emergencies, Massachusetts General Hospital' 1977-1978 Director of dog. laboratories for courses on emergency medicine and respiratory emergencies, Massachusetts General Hospital n 1977-1978-Co-Coordinator and Iacturer for the Management of Medical and Surgical Eiisu. p cies, Massachusetts General Hospital I. 1979. Iacturer for the Fami :,

d. of Medical and Surgical' E - vercies Course, Massachusetts General Hospital 1978-1982,.1983-1984 Iacturer for Eii

,.v cf Medical Technician Courses, Mount Auburn Hospital 1978-1982, 1983-1984 Clinical Instructor to third and fourth year w=iimi students en core and elective - clerkships in emergency medicine, Mount Auburn Hospital 1978-1982, 1983-1984 Iacturer and participant in Emergency Unit Conferences, Mount Auburn Hospital 1979-1982, 1983-1984 Attending Physician, Medical Service, Mount Auburn Hospital 1980 Iactures.on Medical Effects of Nuclear Power and Radiation Accidents: given in Augusta, Maine, Sepem*=r; Grand Rounds, South Shore Hospital, Weymouth, Mk, September; Plymouth Town Meeting,. =! Plymouth, MA, November, q 1981 Iactures on Medical Aspects of Radiation Accidents: i given at University of Massachusetts Medical. S2ool, Worcester, MA, April.. Iactures an Emergency Response to Nuclear Accident /. . Attack: given at the Second World Coi@. ass on. Emergency and Disaster Medicine, Pittsburgh, PA, June; IGesne State Cbilege, ICaene, NH, ' November; Annual Meeting of the massachusetts Association of. Physicians'-Assistants, Boston, MA, November; Arlingten Town Meeting, Arlington, MA, November. 1982 Iacture on Medical Aspects of Civil Defense: given-at the University of Connecticut School of 1 Medicine Synposium on the Medical ~ consequences of Nuclear Weapons ard Nuclear War, Farmington, CI', March. Imature an Disastar Plannirug for the '80's: given at Grand Rounds, University of Massachusetts Medical'S&ool, Worcestar, MA, March. Iseture on the Civilian-Military Contingency Hospital System: given at Harvard Medical Area Symposium, Boston, MA, March.

q ,.4' L y Teaching Experience (Continued):- O 1982 (Continued) Delegate to the Second International Cusp ss for-3 the Prevention of Nuclear War, Cambridge, England, April.- Testimony before the U.S. House 91v=aittee on Environment, Energy and Natural Resources Hnarings on Crisis Relocation, Washington,- D.C., April. Iacture on the Medical Consequences of Nuclear War: given at the International Synposium.on the Morality and Imgality of Nuclear Weapons,; New York, NY, June. Testimony on survival after Nuclear War before the Boston City Council' Hearings on Crisis-Relocatica1, Boston, MA, June. Testimony on Civil Defense before Annual Meeting' of the U.S. Civil Defense Council, Portland, Oregon, October. Iacture on Civil Defense and Nuclear War, given at Synposium on the 0:nnequences and Prevention of Nuclear War, University of New Jersey Medical School, Newark, MI, October. Iacture en Civil Defense and Survival, given at.the First Biennial Conference cm the Fate of the Earth, Coltambia University, New York, NY, October.' Iacture on the Physician's View of 00CHS, given at Radiology Grand Rounds, Brigham and Wcznan's Hospital, Boston, November. Welocane address to the New England Regional Conferenos of PSR and workshop leader on civil defense issues,. Cambridge, MA, November. Imetures on Issues of Icng-term Survival, given at Synpositan on Aspects of Nuclear War, McGill University, Montreal, Canada, and at Synposium en MarHr=1 Consequences of Nuclear Weapons and Nuclear War, University of Minnesota Medical Sdicol, Minnesota, November. 1983 Iacture on Survival' Issues after Nuclear War, PSR Annual Meeting, San Francisco, CA, January. 01 air of Panel en the Physician's Role in the Prevention of Nuclear War, organized by the Greater Boston Qiapter of PSR, Boston, MA, February Imeture on Medical Aspects of Survival After Nuclear War, Etsnanuel College Seminars, Boston, MA, February. Iacture on Civil Defense and Disaster Management, given as part of the lecture series in the Harvard Medical Sdiool ocurse on Nuclear War, Boston, MA, Mart:h. = - - - _ - _ _ _ - - = _ _

q ' x, y _6 Teaching Experienca (Continued): 1983;(Continued) Iacture cri Medical Omnsequences of. Nuclear Weapons

and Nuclear War, givert at Synposium on " Issues j)

-in the Ntaclear Age: Applications for h aching," sponsored by the New York City: Board of J Biucation, New Ycek, NY, Martit.' Test 3Juany before the 0:ssnittee on Public Safety, l Massactiusetts State House, Boston, MA,. April. Annual Inster G. Houston Memorial Iacture, { ,1 f " Survival;After Nuclear War," Bridgewater State { college, Bridgewater, Mk, April. Iacture an Mar 1W1 Aspects of Nuclear War, given at-i. forum held by the Voluntary Services Advisory council of the Massectiumetts Hospital Association, Boston, Mk,' April. Iacture on Disaster Management Strategies for Nuclear War, given at the plenary _ session of the 'mird World Congress on Ee.m y and ' c Dimaster Medicine, acne, Italy, May. Delegate to the '1hird International C%s s for the Prevention of Nuclear War, Amsterdam,, Netherlands, June.- Iacture on the Illusion of Survival: Civil Defense for Nuclear War, given at-the Washington University of St. Iouis Synposium on Medical C2nesquences of Ntaclear Weepans and Nuclear - War, October. Iacture on Disaster Managsmarit and Civil Defense, . Public Forum on 'me Day After, Kansas City, November.- 1984 Director of civil defense worLJ @, PSR Annual Meeting, Washington, D.C., January. Iacture on Civil Defense in Nuclear War, Harvard Medical School course _an Medical Aspects of' Nuclear War, Martit. Iacturer en Civil Defense and Nuclear War, University of Illinois School of Medicine,- Mictieel Reese Hospital, Department of Medicine Grand Rounds, and University of' Chicago,' Pritzker Sdicol' of Medicine, Februery. Member of PSR Descutive Cansmittee study tour of Moscow and Ianingrad, guests of Soviet ~ Physicians for the Prevention of Nuclear War, Mardt-April, 1984. chair of the Working Group on Physician Resistance to Preparations for War, a two day seminar held as part of the Fourth World CEsse of the ' International Riysicians for the Prevention of i Nuclear War, Helsinki, Finland, June, 1984. i 1

iQg_ a ' o 'r t - Teaching Experience'(Continued): - 1984 (Continued) Participant-in the Massa &usetts M Hoc'Consnittee : c . on Crisis Relocation, whi& was instrumental. in ' bringing about Descutive Order'242 '(renouncing svar:uation' and shelter and affirming prevention ' as the otzemonwealth's response to the threat of raaclear war) and in the establishment of'the. ~ Govenor's Mvisory Committee on the Impact 'of p the Nuclear Arms Raos on Massachusetts Citizens 2 and the Massa &usetts Econcary.. Participant in the Sandnars of the Harvard Nuclear ' Psy& ology E,-, Department of Psychiatry, Harvard Medical S& col. Presentation entitled, " Educating'for Peace,"' Ainarican Association of University Wcman Regional conference, October.- Presentation entitled,!"An Analysis of Civil ~ Defense Resear2," Seminar Series, Program in Science, Technology and Society, Massachusetts Institute of Te&nology, Ciubridge, MA, nenmehar. Participant in the American Friends Service mittaa Study Tour of the Mideast, i November 10 - Dan==har 1. Organized to introduce U.S. peace and disarmament activists-to the ocuplexities of the Mideast crisis. 1985 Chair of a seminar an current civil defense strategies,= Annual Meeting of lhysicians for Social Responsibility, Ice Angeles, CA, February. Lectures cra Civil Defense in Nuclear War and Biological Effects of Radiation in War, Harvard - Medical School Course on Medical Aspects of Nuclear War, March and' April. - (, Lecture on the History and IN1% of Civil-I Defense in the U.S., National Colloquim of Ohio Wesleyan University,- April. Chair of the Working Group cri International arrl National Civil Defense Strategies, Fifth otzigress of the International Physicians for the Prevention of Nuclear War, 8* 9 t, mangary, June. Iacture on Survival After Nuclear War, Public Health Aspects, MIT/ Harvard Arms control Studies R- @ am, June. Participant in panel an Trinity Plus Forty - Scientific Responsibility and The Bomb, Forum-I at IGennedy School, Institute of Politics, July, 1-l' l l l

p:. s Gg. c a j ' ',.c j . ' Teaching Experience'(Continued): 11 1985-(Continued) Steering Ocanittee Manhar for the Institute of Medicine Synposium entitled, " Medical l Implications frt:sa Recent Studies of Nuclear' 1 War." Invited paper en triage on burn and blast injuries,: sponsored by the Institute of Medicine and the fiational, Academy of Sciences, Sagt=+=r. - Isture on Public Planning Policies for Nuclear-War, Anmal Meeting of University Association of Urban Planners,' Atlanta Georgia, November.' ~ Iacture on Survival. after Nuclear War,. Biological 'and Public Health Issues, Honors Colloquim,. University. of Rhode Island, Novanhar. Participant Delegate, International Physicians for the Prevention of Nuclear War, Nobel Peace Prize Award Omrumonies, Oslo, Norway,. December. 1986. Imeture on Social costs of the Arms Race, Boston Massum of Science Synposium for Educators on Issues of Nuclear War, Jarmary. Imetures on Civil Defense in Nuclear War and Biological Effects of Ra<ilation in War, Harvard i Medical Sc ool' course on Medical Aspects of Nuclear War, Martti and April. Seminar Presentation to Radcliffe Project on Interdspendanos on Decision-making Under Stress: Case studies in Disaster Management, Martit. Imeture en Disaster Management, nwnert Emergencies L. Map, Harvard causunity Health Plan, April, 1 Seminar Presentation to Radcliffe Project on Interdependence en' Decision-Making Under Stress: Three More Chae Studies in Disaster Manegament, April.: Imcture an' the role of Health Professionals in'the-Nuclear Age, Social Medicine Course, Boston University S&ool of Medicine, May. Lecture an Survival After Nuclear War, Public Health Aspects, MIT/ Harvard Summer Pixysam on Nuclear War and Arss Control, June. ACIS Certification and Racertification course for Bri k and W ann's Hospital House Officers, June. Iacture on Triage in Nuclear War: The Management of l Mass casualties frun the Perspective of U.S. j War-time Experianos, Quartarly Staff Meeting, Benedictine Hospital, Kiry.u, NY, September. [ Iacture on Nuclear Winter and the Icnger-Term i consequences of Nuclear War, International i Scientific Synposium, World Cwys of l Cardiology, Washington, D.C., September. 1

>;w > _ .l l ^ l l s [:

~9-p Tead ing Experience (Continued):

Y L1986-(Continued)' ACIS Certification courise for HO!P physicians, October.. L_ Iactura en Disaster Management, BWH energency i/3 conference, October. Lecture on Nuclear Disasters ard the View from C-41, New England Medical Center,. November. I Iacture on the Ct= 4 1 Disaster, seminar for. PSR speakers, Boston, nar=her. 1987 Delegata, International Peace Forus, as guest of .the Soviet Academy of Medical Sciences, Moscow, February. 1 Plenary lecture on Systems Failures in Disaster 'and seminar leader on Civil' Defense Issues, FSR Anr1ual Meeting, 011cogo, Mart:h. ACIS Certification ocurse for HCHP phy 1cians, Hardt. Lu:tures cri Biological Effects of Radiation in War and civil Defense for Disasters and Nuclear War, Harvard Medical S & ool Course on Health Aspects of Nuclear War, Mards and April. Iacture on History of U.S. Civil Defense ard Disaster Planning, Brown University Medical S @ ool course en Nuclear War, Providence, RI, April. Iacture on Decision-Making Under Stress: A Pers;pmetive on Diamatets, H rvard Club of Bosten Spring Iacture 3eries, April. ACIS certification course for Bei house officers, Bostcrt, CNne. Ccalcultant to the 0:ssenwealth of Massachusetts, on emergency medical planning for Seabrook nuclear power plant, Boston, Augupt-September. Seminar en Decisionitaking Under Stress case 1 study of Ih41='t=1?ia MWE action Harvard

1988 Tratana Study Group, Boston, Sopran*=.

Consultant to the 'Dires Mile Island Public Health Advisory INnd cri emergwicy medical. planning for 'Ihree Mile Islard nuclear power plant, Boston and R111adelphia, January - October. Field investigator with delegation frt:m Ehysicians 4 for HLaan Rit#1ts, Israel, West Bank, and Gaza, February. Panelist on Tratana in the Ocx:upied Territories Harvard Medical S&ool, Boston, February. Keynota speaker, 'Ihe Illusien of SDI, Annual Meeting of Physicians for Social m anspcsiribility, California, Mardi. Medical Grand Rounds, 'the Medical consequences of Nuclear War, Suttav Health, Sacramento,

April, l'

,, j ) 4 . g; 4.. Teaching Euperience ' (Ctritinued) : 1988 (Ccritintwd) Guest lecture, Triage and Nuclear War, Sacramento l Chapter of Riysicians for Social Respesibility, Sacramento, April. Incture en Civil Defense, Harvard Medical School Course on Nuclear War, Boston, April. Iacture, MmMm1 Implications of the Uprising. in the led Territories, Herinady School,

Boston, Iactures,'

Defense and Nuclear War, seminar l for regional civil defense officials,. Federal Management Agency, Danittsburg,' MD, Imeture, met if Nuclear War Omnes, Cambridge 1 Seminar on, Medical consequences of Nuclear War, 1 Focus Cambridge, May. University of pnamar*1usetts at Boston, study f series for hic #1 s&ool ten &ars, Boston, May. 1 Incture cri Interinediate and Img-Term consequences of Nuclear War, Eidsth Congrams of International-Physicians for the Prevention of i Nuclear War, Montreal, June. Imeture, In Dreams Begin Responsibilities, Imeture Series, Basten University, Bosten, October. 1 Acts omrtifimtion ocurse for HmP physicians, i Boston, october. Panalist on the Caprehensive Test Ban Treaty,. Space Bridge course between 'ntfts University and Moscow State University, Bostcas, er+=2. Incture on MMimi Ethics in Ly cf Practice, American MmMm1 Students Association Annual Masting, Basten, october. .1. Lecturn, Systematic Trmana in the occupied Territories, Penal on Itaman Rights Violations, American Public Health Association Annual Masting, Baste,. November. Principal Clinical.and Hospital Service Responsibilities: 1977_-1978 Emergency Rtysician, Harringtm Memorial Hospital ( m Physil:ia Wing Masorial Hospital, Palmer, m. i Emergency Physician, IcWall Genera. Hospital, Lvi, m. Staff Physician, Ranhar Hill Health Center, O mrlesteun, m. Staff Riysician, Asbulatory Screening Clinic, Phasa&usetts General Hospital, Boston, MA. 1978-1982, 1983-1984 E.- v cf Staff Physician, Mount Auburn Hospital, Cambri&Ja, m.

. : 4.. .' Principal Clinical and Hospital Service Responsibilities (Ocmtirmed): 1982-1983 Destgency Staff Physician, Newton-Wellesley Hospital and Qtrney Hospital. 198/.- Chief of h w y Services, Harvard Ctanunity c Health Plan. 1986-Lw.y Staff Physician, H3fP Einma.w y Service c at Bricpues and Wann's Hos Attending E w y Physician,pital. c Brigham and Wmen's, Hospital. 1988-Special Assistant to the Medical Director, Harvard OEmeJnity Health Plan. Bibli v piy: Reviews: Link JL..leview~of the Wanen Patient: Voluna I, Notaan MP and Nadelson CC, eds. Soc Sci and Med. 1979: 13A:830-831. Imaning J. Review of led Report, Effects of Nuclear War on Health and Health Services, Envirassental T==rt W Review 1986: 9:99-103. Vi h==: Link JL. Einw.w f Management of Asthem. 1978: Massactiusetts General c Hospital E w y Videotape Series. c Imgal Briefs: Principal author of section to Suppene Judicial Court for the Omnonwealth of Massediumetts, Moe v. Hanley, No. 2231. Amici Curiae. September, 1980. Publications: Doncutive Qassittee, Physicians for Social Responsibility, Medical care in Modern Marfare, NEJM 306:741-3, principal author. Y J. Civil Defense in the 14aclear Age, Testimony presented to the on 7breigt Relaticne, U.S. Senate, Record of Hearings on U.S. asuL$sriet civil Defense Prtxjness, Mart:2116 and 31,1982. ~3';g J. Barcpean Civil Defense Planning, T==*4M presented to the House __- i@ Ozedttee, 2*w==4ttee en Environment, Energy, and Natural Resources, U.S. House of Representatives, Rooord of Hearings, April 22, 1982. Imaning J. Civil Defense in the Nuclear Age: Itiat Purpose Does it Serve and itat Survival Does It Praaise?, published and distributed by PSR,- Ombridge, 1982.

7 6 i o

• Bibliogregty (Continued):

Publications (Ocntinued): ( Link JL. hw f Response to Nuclear Accident / Attack. FE-:--- 14 rns of c the Second World 0:rigress on be f and Disaster Medicine, Pittsburgh, c PA, June,1981. Imaning J, Imighten M. 2e World According to 11Mk: Prupering to Survive Nuclear War. Bull. Atcm. Scientists, 1983:39: E Imanhig J,i Fayes L, eds. Se Counterfeit Ark: Crisis Relocation for. Nuclear War Ballinger, Cambridge, Mk, 1984. J. Civil Defense Planning for 14aclear War. C Manni, SI Magalini, eds. D Medicine. Springer Verlag, New York, 1985. Imaning J, Imaf A. Public Health Aspects of Nuclear War. Ann. Rev. Health 1986:7:411-39. Ianning J. Burn and Blast casualties: Triage in' Nuclear War. F Sol man, RQ Marston, eds. Se-MedicL1 Inglicaties of Nuclear War. Institute of Medicine, National Acadsey Press, Washingten, D.C., 1986. Imaning J. Analysis of Current Civil Defense Plan. T==*4=r=1y presented to the House Armed Services Si*menittee en Military Installations and. Facilities. U.S. House of Representatives, Racced of Hearings, March 27, i 1987. i Geiger J, Imanirq J. Nuclear Winter and the Ia.p-Term Ocneequences of Nuclear War. Prov. Med. 1987:16:308-18. Imaning J.^ Se FEMA Civil Defense Fswys , Bull. Atcst. Scientists 190,7:43:42-46. Daley W, Ianning J, keen R. Ito Telephone Triage and E ,cy. Medicine. J. Bestg. Med 1988:6:333-338. Imaning J. Physicians, Triage, and Nuclear War. Lancet 1988:8605 269-270. L Iggend(shed Repotts: vp. Lindt JL. Evaluation of Pre-Test Ptgulation Questionnaire ackninistered in rural himen. U.S. Agency fro Internaticsial Develegnant, September,1969. I Link JL, et al. m e M M-South Health Plan. Report.to the Board of Di m h. of the Mid-Southside Health Planning Organization and to the office of Economic Oppcetunity, Chicago,1971. Link JL. Report of Sita Visit to Salen Hospital Bnergency Service, Sulaitted to Saleet Hospital Board of Dir.ct,s., February, 1978. i i

t \\ ) .s- _13 BibliogrW (Ocntinued): Unpublished Wt.,(Ccotinued): . Link JL, et al. Position Paper of Physicians for Social Responsibility on the civilian Military 0:mtingency Hospital System.. Physicians for Social Responsibility, Cambridge,.19L, October,.1981. Daley W, Imaning J, et al. Emergency Telephune Triage Manual, Harvard Qamunity Health Plan Emergency Service,1986. Leanirq J. Health Ocmsequences of Radiation Byn and Issues of hv wf Evacuation, Report for the Ahu y General, Otanonwealth of Massadiusetts,1987. Leaning J. Issues of hv cy Mim1 Plaming. Report for the ) 'Ihree Mile Island Public Health Advisory Fund, Philadelphia,1988. i Niryar HI, Imanirg J, Shapiro L, Simon B. Casualties of Cctiflict: Report on the Medical Pact-Findisq Missiczi to the West Bank and Gaza. Mtysicians ] for Ranan Ri$sts. Boston, 1988. In Preparation: Weiss K Imaning J, Goldman P. Emergency Room Patient Transfers: An Eva61uat1cn of Ambulance Records as a Scurce for Surveillance Data. Sulatitted to Health Services Researt:ft, October,1988.. Imaning J. Planning for the Treatment of Casualties After Nuclear War:- An Analysis of the 1988 B9L Report. Sutznitted to the Br Med J, November, 1988. Imaning J, Weiss K. Patient Transfers Betideen Emergency Roans in the Greater Boston Area. To be sutzaitted fall 1988. Imaning J, Gerhart T, Yett H, Livii.,.Mi W, Hayes WC. Medim1 L M 14_m tions of Hip Fracture

A Review of 210 hetients with Femoral Neck Fracture. To be tted fall 1988.

Imaning J, Gerhart T, Yatt H, Livi.,.Wi W, Hayes WC. Dwell Time for Hip Fracture: Measuring Quality of Care. To be sutzeitted fall 1988. idk L o ___}}