ML20235M855
| ML20235M855 | |
| Person / Time | |
|---|---|
| Site: | Seabrook  |
| Issue date: | 02/21/1989 |
| From: | Leaning J MASSACHUSETTS, COMMONWEALTH OF |
| To: | |
| Shared Package | |
| ML20235K640 | List: |
| References | |
| OL, NUDOCS 8902280458 | |
| Download: ML20235M855 (37) | |
Text
, - _ - .
F
- .( !
. ge ,c '
4 .-
UNITED STATES OF AMERICA NUCLEAR REGULATORY COMMISSION
. ATOMIC SAFETY AND LICENSING BOARD Before Administrative ~ Judges:
.Ivan W. Smith,' Chairperson Richard F. Cole' Kenneth A. McCollom
)
In the Matter of. ) Docket Nos.
) 50-443-OL PUBLIC. SERVICE COMPANY OF.. ) 50-444-OL NEW 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 8902280450 890221
-PDR- ADOCK 05000443 T. .
4 EUMMARY OF THE' TESTIMONY 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 resources are needed for persons who are. radiologically injured in various' degrees.
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.
A~ statement of Dr. Leaning's professional credentials was previously submitted in this proceeding in a piece of testimony by her.on the health effects of radiation doses dated September- 14, 1987 on pa,as 9-10. A detailed resume is attached, f.
j' j 3
J. Leaning, M.D.
February, 1989' EMERGENCY MEDICAL RESPONSE TO A MAJOR ACCIDENT AT SEABROOK:
MEDICAL NEEDS AND RESOURCEE l
l The key issues involved in organizing an emergency medical l
response to a major accident at Seabrook include:
l l
- 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 l 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
- 5) Establishment of a system to provide the resources needed to deliver that requisite level of medical response 1
l'.
l.
4 l
1 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: I 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 identifying those at risk of exposure, minimizing ongoing exposure, registering and treating those who have been exposed, and creating a record system suitable for long-term epidemiologic j tracking and follow-up.
1 Specification of the level of medical response that will be needed for each catecorv of person exposed:
1
p !..s ,
1
!.. , e l
- )
? l 5
' overview: J b
J All' people in-the. pathways of exposure must be identified
-1' and records 1 kept of key baseline medical and demographic -. data.
All those whose radiation exposure levels require decontamination or other interventions must be' direct'd e to designated sites'for this' care. All' people with. mixed injuries (radiation and'other injuries resulting from'the' accident) 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 information source for accurate and comprehensive long-term fo2, low-up.
l Medical Triage:
l Those whose history of symptoms'and travel routes indicate a L risk of moderate or substantial exposure to radiation must, after 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
a
.{
6
, m' ore serious exposures.
g ., 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 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 treatment needed. Registration of all people in 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 entire exposed population, must consist of medical and epidemiologic surveillance over a period of at least two generations.)
_ _ _ _ _ _ _ _ - _ _ _ _ _ _ - _ _ - - _ _ - _ _ - _ _ _ _ _ _ _ _ _ _ - _ - __ _ _ _ _ _ - _ - . __________-_a
7 i
Since individual response to a given estimated radiation exposure is known to be variable, it is possible that within several hours of exposure a very small percentage of people exposed at this dose range may become symptomatic (nauseated, vomiting) and seek medical 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 the duration of their symptomatic period (probably not more than a few days).
2)25 to 150 rads:
Approximately 50 percent of people exposed in this dose range will exhibit symptoms of nausea and vomiting. They will evince the 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 I
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 i
o .
- e'
. 8 are potentially contaminated'with radioactivity. (The materials couldLbe sent to an off-site laboratory for' actual assay but the i~ transport time should be minimal.)
3)150 to 300 rads:
range All people in this exposure can - be expected to experience. nausea and vomiting. The majority of people in this category will progress to more severe illness characterized by the hematopoietic 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
_- - -- __ - . . 1
4 9
4)300 to 600 rads:
People in this exposure . category will all require 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 attempted. (In the 13 Chernobyl patients in whom this procedure was attempted, 12 died; the one survivor may have been supported by the bone marrow transplant but his recovery occurred when his own bone marrow regenerated.)
The distinguishing feature of people in this exposure 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 forestalled by medical intervention but not necessarily prevented).
5)Over 600 rads:
Virtually 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.
I l
1 1
l 10 l
)
Allocation Decisions:
Plans to consume scarce resources will provoke allocation i questions. In particular, such resources include inpatient intensive 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.
These allocation issues would play out at the local level, where the lack of open intensive care unit beds would require the transfer of some patients to other areas, possibly out of state.
The challenge then would be to coordinate that national response with sufficient precision so that no patient is harmed in the
>s t 6
.11I f allocation'and transfer process. ,
o ,
. Initial discussion will arise over the question'of who takes precedence: on,what grounds', medical or ethical, can a bed or blood products be given to . a . victim of radiation exposure' as '
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 f o l l o w i n g _ a' young patient in the ICU, recovering; from extensive . surgery after a serious automobile accident will also linsist 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 be followed for the.following allocation decisions:
--what patients to transfer from inpatient beds needed for 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
12 who require admission and treatment at a referral hospital; ,
--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 civilian health care institutions. An intensive educational car:paign )
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.
Establishment of a system to orovide the resources need to deliver the recuisite level of medical resconse:
To support a medical response of this magnitude requires both a medical and logistic organization and a medical resource base.
1 i
~
Medical and Logistic organization:
l l
l- 13 l
Medical personnel will need to be organized into three j echelons of care. The first echelon must be located at the initial triage site to which people will have been told _ to i evacuate, by car or on foot. These triage sites will need to be located outside the exposure sector. At these sites, trained j 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 j sites will need to travel either by ambulance or air transport, as necessary.
t
.l Within the state, in areas adjacent to the accident site but i 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.
6 All medical personnel involved in delivering this emergency care must be be trained in how to perform their roles and drills must be held periodically to ensure that response is maintained
14 at a high level of competence. Lines of authority and communication between and among referral sites must be established in 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 from area, state, and national emergency transport systems'nust 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 within one institution or site of care. Referrals of patients ,
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 l In the setting of a major emergency with hundreds and 1 perhaps thousands of people requiring referral and transport to secure specialty services, it is essential to have established a l
E_ _ _ _ - - - )
15 system that allows providers at the first echelon to' communicate.
up the line and that allows referral centers to relay back when their beds are full or resources expended. These systems must be 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 i
i 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:
The resources required to support this response include i
i 1
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.
In the first category are the hospital-based systems: local-and referral. Both categories of hospital must be prepared in 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. .
l 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 currently employed and in short supply throughout the nation. In the event of an accident, some of these health care workers will 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 1
i
. - _ - - - - _ _ - . - _ _ - . - . _ _ _ - _ _ _ . ~ _ _ . _ - - _ - . _ _ _ _ _ . . - - _ _ . - - - _ _
b
e .
1 17 responsible for moving patients to radiation referral sites l around 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 mobile shelter equipment needed for decontamination on a population scale. Resources that might be dispersed and used for other purposes but must be immediately available for dedicated use during 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 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
- r
]
.4 ,
i 18 question.
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 :etting in motion the command
.o and communications ' systems that will be needed to carry out whatever actual response may be dictated by events.
.Conclusiani 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 agencies 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.
4
_ - . - . _ . .-__n__.-___ ___.________._-____._____--_...------_._.-------_-_-a
'19' REFERENCES Abrams, H.L., "How Radiation Victims Suffer," Bulletin of the Atomic Scientists 43 (1986): 13-17.
1 Andrews, G.A., "The Medical Management of Accidental Total-Body Irradiation," in The Medical Basis for Radiation Accident
' Preparedness. K.F. Hubner and S.A. Fry, eds., Elsevier/ North-Holland, New York, 1980, pp. 297-321.
Cowley, R.A., " Mass' Casualty Needs," in S. Edelstein and M.
Silverstein, eds., Mass Casualties: A Lessons Learned Acoroach.
Proceedings of the First International Assembly on Emergency l
Medical Services, June 13-17, 1982. National Highway Traffic Safety Administration. DOT HS 806 302.. Washington, D.C., 1982, l-pp. 141-145.
i Cronkite, E.P., "The Ef fects of Dose, Dose Rate, and Depth Dose upon Radiation Mortality," in National Council on Radiation
- Protection and Measurements, The Control of Exoosure of the l
Public to Ionizinct Radiation in the Event of Accident or Attack, l
1 NCRP, Washington, D.C., 1982, pp. 21-27. i Evans, J.S, Moeller, D.W., and Cooper, D.W., Health Effects Model for Nuclear Power Plant Acident Consequence Analysis, NUREG/CR- !
[
l 20 4214. SAND-7185. Sandia National Laboratories, Albuquerque, New Mexico, 1985.
Finch, S.C., " Acute Radiation Syndrome," Journal of the American Medical Association 258 (1987): 664-667.
Foster, H.D., Disastere Planninc: The Preservation of Life and' Property, Springer-Verlag, New York, 1980.
Gale, R.P., "Immediate Medical Consequences of Nuclear Accidents," Journal of the American Medical Association 258 (1987): 625-628.
Gale, R.P., " Medical Aspects of Nuclear Accidents," in-American Medical Association, Proceedings of the International Conference on Non-Military Radiation Emergencies, AMA, Chicago, 1985, pp.
38-51.
Geiger, H.J., "The Accident at Chernobyl and the Medical Response," Journal of the American Medical Association 256 (1986): 609-612.
General Accounting Office, Further Actions Needed To Imorove Emercenpy Preparedness Around Nuclear Powerplehts, GAO/RCED 43, U.S. General Accounting Office, Washington, D.C., August 1, 1984.
' l i
l l
.. f l
21 International Atomic Energy Agency, Manual on Early Medical Treatmeent of Possible Radiation Iniurv, Safety Series No. 47, IAEA, Vienna, 1978.
Leonard, R.V., and Ricks, R.C., " Emergency Department Radiation Accident Protocol," Annals of Emercency Medicine 9 (1980): 462-470.
Linnemann, R.E., " Soviet Medical Response to the Chernobyl Nuclear Accident," Journal of the American Medical Association 258 (1987): 637-43.
Lushbaugh, C.C., " Human Radiation Tolerance," in SDace Radiation Bioloav and Related Tooics, C.A. Tobias and P.Todd, eds.,
Academic Press, New York, 1974, pp. 494-499.
Lushbaugh, C.C., "The Impact of Estimates of Human Radiation Tolerance upon Radiation Emergency Management," in NCRP, Washington, D.C., 1982, pp. 46-57 McClellan, R.O., " Health Effects from Internally Deposited Radionuclides Released in Nuclear Disasters," in NCRP, 1982, pp.
28-39.
Mileti, D.S., and Sorensen, H.H., " Planning and Implementing Warning Systems," in M. Lystad, ed., Mental Health ResDonse to
22 Mass Emergencies, Brunner/ Mazel, New York, 1981, pp. 321-345.
National Council on Radiation Protection and Measurements (NCRP) ,
Radiological Factors Affectina Decision-Makinc in a Nuclear-Attack, NCRP Report No. 421, Washington, D.C., November 15, 1974.
National Council on Radiation Protection and Measurements, Manacement of Persons Accidentally Contaminated with Radionuclides, NcRP Report No. 65, NCRP, Washington, D.C., 1980.
l Perry, R.W., and Nigg, J.M., " Emergency Preparedness and Response Planning: An Intergovernmental Perspective," in Lystad, ed.,
l 1988, pp. 346-370.
Poda, G.A., " Decontamination and Decorporation: The Clinical Experience," in Hubner and Fry, eds., pp. 327-332.
Raker, J.W., Wallace, A.F.C., Rayner, J.F., and Eckert, A.W.,
Emercency Medical Care in Disasters: 'A Summrv of Recorded Experience. Disaster Study No. 6. National Academy of Sciences.
National Research Council. Washington, D.C., 1956.
Rotblat, J., Nuclear Radiation in Warfare, Stockholm International Peace Research In stitute, Oelgeschlager, Gunn &
Hain, Inc., Cambridge, Mass., 1981, pp. 34-35.
i
~
I 5
23 Rund, D.A., and Rausch, T.S., Triaae, C.V. Mosby, St. Louis, 1981.
Silverstein, M.E., Triace Decision Trees and Triace Protocols:
Chancina Stratecies for Medical Rescue in Civilian Mass Casualty Situations. Federal Emergency Management Agency Contract No.
EMW-C-1202. National Technical-Information Service, Springfield, Virginia, 1984.
Thoma, G.E., JR., and N. Wald, "The Diagnosis and Management of Accidental Radiation Injury, Journal of Occupational Medicine (August 1969): 421-447. ,
l United States Nuclear Regulatory Commission, Reactor Safety l Study:
An Assessment of Acc. dent Risks in U.S. Commercial Nuclear Power Plants, WASH-1400 (NUREG 75/014), Washington, D.C.,
1975, Appendix VI, 9-3.
United States Nuclear Regulatory Commission, Report on the Accident at the Chernobyl Nuclear Power Station, NUREG-1250, Rev.1, Washington, D.C., 1987.
United States Nuclear Regulatory Commission, Implications of the Accident at Chernobyl for Safety Reaulation of Commerical Nuclear Power Plants in the United States, NUREG-1251, Washington, D.C.,
1987.
- - - - - _- ___A
- r. - - - - - - - - - - - - - - - - - - -
b .
l' l
24 l
Voelz, G.L., current'Ancroaches to the Manaaement of Internally Contaminated Personsin in Hubner and Fry, eds., 1980, pp. 311-325.
1 1
j i
I
CURRICULUM VITAE l
Name: Jennifer Isaning (Link)
Address: RFD 4, 113 Tower Road, Lincoln, MA 01773 Telephone: 617-259-9108 (Hcne)
Place of Birth: San Francisco, California Education:
1968 A.B. Radcliffe College 1970 M.S. Harvard School of Public Health 1975 M.D. University of Chicago 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. Solcmon, (then Dean at Radcliffe): History of American Women Research 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 annotating letters of women
( suffrage activists 1968 Summer Assistant to the Director; Population Service, Agency for International Development: developed three-dimensional 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 trainirg manual to instruct field workers in the use of the revised interview; supervisor Dr. David Heer, Harvard School of Public Health 1970-1971 Associate Director of Mid-Southside Health Planning Organization, Chicago, Illinois: wrote several assessments of health care nauk of population of southside Chicago; principal author of successful grant proposal to Office of Econcnic Opportunity for establishment of four neighborhood health centers in that area l 1972-1973 Data analyst for hypertension program using computer 1- protocol for drug treat 2nent; supervisor, Frederic Coe, M.D., Michael Reese Hospital l
l
Postdoctoral Training i Internship and Residencies:
1975-1976 Intern in Medicinc, Massachusetts General' Hospital 1976-1977 Resident in Medicine, Massachusetts General Hospital l
1977-1978 Clinical Fellow in Medicine, Massachusetts General Hospital Licensure and Certification:
1976 Diplcanate, National Board Of Medical Examiners 1977 Maatuchusetts License Registration 1978 Diplcunate, American Board of Internal Medicine 1980 Instructor Certification, Advanced Cardiac Life Support 1983 Certification, Provider, Advanced Trauma Life !
Support 1984 Diplcznate, American Board of Emergency Medicine 1986-1988 Re-certification, Provider, Advanced Cardiac Life ,
Support 1 Re-certification, Instructor, Advanced Cardiac Life Support Academic Appointments:
1975-1978 Clinical Fellow in Medicine, Harvard Medical School 1978-1982, 1983-1984 Clinical Instructor In Medicine, Harvard Medical School 1986- Instructor in Medicine, Harvard Medical School 1983-1985 P - rch Affiliate, laboratory of Architectural Sciences and Planning, Massachusetts Institute of Technology 1983-1984 Scholar-in-residence, Radcliffe College ,
1984- Visitirg Scholar, Radcliffe College -
1986-1988 Research Associate, Institute for Health Pa= arch, Harvard University Hospital Appointments:
1975-1978 Assistant in Medicine, Massachusetts General Hospital 1978-1982, 1983-1984 Attending mysician, Department of Medicine, Mount Auburn Hospital 1982-1983 Attending Physician, Newton-Wellesley Hospital Attending Physician, Carney Hospital 1984-1986 Attending mysician, Harvard Ccemunity Health Plan Hospital 1986- Attending Physician, Brigham & Women's Hospital
g ..
- Awards and Honors:-
1968 A.B. magna cum laude Captain Jonathan Fay' Prize-Senior Sixteen Phi Beta Kappa
, 1970 Briggs Fellowship, Radcliffe College
} 1975 M.D. With honors Upjohn Award Alpha Omega Alpha Major Committee Assignments:
Hospital: l 1979-1981 Infectious Di=aaaa Ccanittee, Mount Auburn Hospital 1983-1984 Joint Conference Ctanittee, Mount Auburn Hospital 1985-1986 HGP-H Maelim1 Executive Ctenittee 1986-1987 Patient Care Ccmnittee, Brigham & Women's Hospital
'and Harvard Cannanity Health Plan
' Memberships, offices and Ccanittee Assignments in Professional Societies:
1979- Physicians for Social Responsibility Descutive Ctanittee and Board of Directors 'i 1979-1984 (Chair frun 1979-1981 Secretary 1983-1984 Treasurer 1984)
Acting Medical Director 1982 Long Range Planning Group 1984-(Chair 1984-1986)
Board of Directors,1987-1981- American College of Eunupcf Ihysicians 1982- American Public Health Association 1985- Co-chair, Governor's Advisory Ccanittee on the Inpact of the Nuclear Arms Race on Massachusetts 1985-1987 Chair, Rapid Rairriss6 Fund Ccmnittee, Medical Advisory Task Force, U.S.A. for Africa 1985- Member, Arms Control Advisory Comittee to Senator John Kerry 1987- Consultant to the Cumnonwealth of Massachusetts i on Emergency Medical Planning for the Seabrook Nuclear Power Plant 1987- Consultant to the Three Mile Island Public Health Advisory P.Ind on Emergency Medical Planning for the Three Mile Island Nuclear Power Plant l 1
.=
Teachirq Experience:
1977-1978 Organizer of three two-week courses on Emergency Medicine at Massachusetts General Hospital 1977-1978 Iscturer on respiratory emergencies, Massachusetts General Hospital 1977-1978 Director of dog. laboratories for courses on emergency medicine and respiratory emergencies, Massachusetts General Hospital 1977-1978 Co-Coortiinator and Iscturer for the Management of Madim1 and Surgical Emergencies, Massachusetts General Hospital 1979 Iscturer for the Management of Madim1 and Surgical Dnergencies course, Massachusetts General Hospital 1978-1982, 1983-1984 Iscturer for Emergency Madim1 Technician Courses, Mount Auburn Hospital 1978-1982, 1983-1984 Clinical Instructor to thirti and fourth year madiml students'on core and elective clerkships in emergency medicine, Mount Auburn Hospital 1978-1982, 1983-1984' Iscturer and participant in Emergency Unit Conferences, Mount Auburn Hospital 1979-1982, 1983-1984 Attending Physician, Madi m1 Service, Mount Auburn Hospital. .
1980 Isctures on Medical Effects of Nuclear Power and.
Radiation Accidents: given in Augusta, Maine, September; Grand Rounds, Sotr h Shore Hospital, Weymouth, MA, September; Plynouth Town Meeting, Plymouth, MA, November.
1981 Isctures on Madimi Aspects of Radiation Accidents:
given at University of M - chusetts Medical !
School, Worcester, MA, April.. 1 Iactures on Emergency Response to Nuclear Accident /
Attack: given at the Second World Congress on Elemupiy and Disaster Meeticine, Pittsburgh, PA, June; IGeene State College, Keene, NH, Novunber; Annual Meeting of the Massachusetts Association of Physicians' Assistants, Boston, MA, Novenber; Arlington Town Meeting, Arlirgton, MA, November.
1982 Iscture on Medical Aspects of Civil Defense: given at the University of Cuubcticut School of Medicine Synposium on the Medical Consequences of Nuclear Weapons and Nuclear War, Farmington, CT, March.
Iacture on Disaster Planning for the '80's: given at Grand Rounds, University of Massachusetts Medical School, Worcester, MA, March.
l Iscture on the Civilian-Military contingency l
Hospital System: given at Harvard Medical Area Synposium, Boston, MA, March.
I i
l l
I l
Teaching Experience (Continued):
J 1982 (Cbntinued)- Delegate to the Second International Cuis; c:ss for I the Prevention of Nuclear War, Cambridge, England, April. 4 TestimcrTy before the U.S. House S*'munittee on Enviu .t==,t, Energy and Natural Resources Hearings on Crisis Relocation, Washington, ,
D.C., April. _I Lecture on the Medical Consequences of Nuclear War: given at the International Sy @ osium on the Morality and Tagality of Nuclear Weapons, New York, NY, June.
Testinony on Survival after Nuclear War before the Boston City Council Hearings on Crisis Relocation, Boston, MA, June.
Testimony on Civil Defense before Annual Meeting of the U.S. Civil Defense Council, Portland, Oregon, October.
Iscture on Civil Defense and Nuclear War, given at Syg osium on the Consequences and Prevention of Nuclear War, University of New Jersey Medical School, Newark, NJ, October.
Iacture on Civil Defense and Survival, given at the First Biennial Conference on the Fate of the Earth, Columbia University, New York, NY, October.
Iacture on the R1ysician's View of ODIS, given at Radiology Grand Rounds, Brigham and W m en's Hospital, Boston, November.
Welo m e address to the New England Regional Conference of PSR and workshop leader on civil defense issues, Cambridge, MA, November.
Lectures on Issues of Iong-term Survival, given at Sy g osium on Aspects of Nuclear War, Mo3111 University, Montreal, Canada, ard at Symposium on Medical Crs__ T = c s of Nuclear Weapons and Nuclear War, University of Minnesota Medical School, Minnesota, Novamhar.
1983 Iacture on Survival Issues after Nuclear War, PSR Annual Meeting, San Francisco, CA, January.
Chair of Panel cri the Physician's Role in the Prevention e' Nuclear War, organized by the Greater Boston Chapter of PSR, Boston, MA, February lecture on Medici.1 Aspects of Survival After Nuclear War, Emanuel College Seminars, Boston, MA, February.
Iacture on Civil Defense and Disaster Management, given as part of the lecture series in the Harvard Medical Sdiool course on Nuclear War, Boston, MA, Marth.
Teaching Experience (Continued):
1983 (Continued) Iacture en M W 1 Consequences of Nuclear Weapons and Nuclear War, given at Synposium on " Issues in the Nuclear Age: Applications for Teaching,"
sponsored by the New York City Board of Education, New York, NY, March.
%stimony before the Ctanittee on Public Safety, Massachusetts State House, Boston, MA, April.
Annual laster G. Houston Memorial Lecture,
" Survival After Nuclear War," Bridgewater State 0311ege, Bridgewater, MA, April.
Lecture on Medical Aspects of Nuclear War, given at forum held by the Voluntary Services Advisory Council of the Mammachusetts Hospital Association, Basten, MA, April.
Lecture on Disaster Marnpaimit Strategies for Nuclear War, given at the plenary session of the Third World cvistoss on Emergency and Disaster Medicine, Rame, Italy, May. ;
Delegate to the 'Ihird International Corytass for the Prevention of Nuclear War, Amsterdam, Netherlands, June.
Lecture on the Illusion of Survival: Civil Defense l for Nuclear War, given at the Washington i University of St. Louis Synposium on Medical Consequences of Nuclear Weapons and Nuclear l
t War, October.
Lecture en Disaster ManEmpainit and Civil Defense, Public Forum on The Day After, Kansas City, November.
1984 DirrL+ct of civil defense workshops, PSR Annual M W .ing, Washington, D.C., January.
Iacture en Civil Defense in Nuclear War, Harvard Mim1 School course on Medical Aspects of l
Nuclaar War, March.
Iacturer on Civil Defense and Nuclear War, University of Illinois School of Medicine, 1 Michael Reese Hospital, Department of Medicine Grand Rounds, and University of Chicago, Pritzker School of Medicine, February.
Member of 'PSR Executive C:mnittee study tour of I Moscow and Ianingrad, guests of Soviet Physicians for the Prevention of Nuclear War, March-April, 1984.
01 air of the Working Group on Ihysician Resistance to Preparations for War, a two-day seminar held as part of the Fourth World Cuiytuss of the International Physicians for the Prevention of ~
Nuclear War, Helsinki, Finland, June, 1984.
Teaching Experience (Continued):
1984 (Continued) Participant in the Massachusetts Ad Hoc Committee on Crisis Relocation, which was instrumental in bringing about Dcocutive Order 242 (renouncirq evacuation and shelter and affirning prevention as the c._..._ = lth's response to the threat of nuclear war) and in the establishment of the Govenor's Advisory Otanittee on the Impact of the Nuclear Arms Race on Ma uachusetts Citizens and the Massachusetts Econcery.
Participant in the Seninars of the Harvarti Nuclear
,L Psychology Piwtam, Departnant of Psychiatry, Harvard Medical School.
Presentation entitled, "Educatirq for Peace,"
American Association of University Women Regional- Ocmference, Octier.
Presentation entitled, "An Analysis of Civil Defense Paaaarth," Seminar Series, PcWsam in Science, TectJ1 ology and Society, Massachusetts Institute of 'nxinology, Cambridge, MA, M r.
Participant in the American Friends Service Ctenittee Study Tour of the Mideast, November 10 - December 1.- Organized to introduce U.S. peace and dia m amant activists to the ocuplexities of the Midaast crisis.
1985 Chair of a seminar on current civil defense strategies, Annual Meeting of Physicians for Social Responsibility, Ims Angeles, CA, February.
Iactures est Civil Defense in Nuclear War and Biological Effects of Radiatic'n in War, Harvard Madim1 School Course on Madimi Aspects of Nuclear War, Marth and April.
Imeture on the History and Philosophy of Civil
- r. Defense in the U.S., National Collcquim of Ohio I Wesleyan University, April. .
Q1 air of the Working Group on International and National Civil Defense Strategies, Fifth Cu ytass of the International Physicians for the Prevention of Nuclear War, Bvhnant, Hungary, June.
Iacture on Survival After Nuclear War, Public Health A==ta, MIT/ Harvard Arms Control Studies Fr@ cam, June.
Participant in panel on Trinity Plus Forty -
Scientific Responsibility and 'Ihe Bcanb, Forum at Kennedy Sdiool, Institute of Politics, July.
I 1
1 1
W.
o ;;.,
.g ,
.s.-
' haching Experience : (Continued) :
1985 (Continued)' Steering Comittee Member for the Institute of -
, Medicine Synposium entitled, " Medical l . Implications fran Recent Studies of Nuclear
, War."' Irwited paper on triage on burn and. _
blast injuries, sponsored by the Institute of Medicine and the Naticrial Academy of Sciences, L Set #mnhor.
i Iacture on Public Planning Policies for Nuclee.-
War, Annual MeetirxJ 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,. November. -
Participant Delegata,-International Physicians for the Prevention of Nuclear War, Nobel Peace Prize Award Ceremonies, Oslo, Norway, December.
1986 Lecture on Social Costs of the Arms Race, Boston 14mamun of Science Synposium for Educators on Issues of Nuclear War, January.
Iactures on Civil Defense in Nuclear War and Biological Effects of Radiation in War, Harvard Medical School Course cri Medical Aspects of -
Nuclear War, March and April.
Seminar Presentation to Radcliffe Project on Interdependence on Decision-making Under Stress: Case Studies in Disaster Management, March.-
Iacture on Disaster Marwpenarit, Ocataan Emergencies Won 44ip, Harvard Connunity Health Plan, April.
Seminar Presentation to Radcliffe Project on Interdependence on Decision-Making Under Stresa: 'Ihree_More came Studies in Disaster Marwpunarit, April.
Incture cri the role of Health Professionals in the Nuclear Age, Social Medicine Course, Boston University School of Medicine, May.
Lecture on Survival After Nuclear War, Public Health Aspects, MIT/ Harvard Sumer Pw: am on Nuclear War and Arms Ocritrol, June.
ACIS Certification and Racertification course for Brigham ard Wcanan's Hospital House Officers, June.
Lecture on Triage in Nuclear War: 'Ihe Management of Mass Casualties frun the Perspective of U.S.
War-time Experience, Quarterly Staff Meeting, Benedictine Hospital, Kingston, NY, September.
Iscture on Nuclear Winter and the longer-Term ocnsequences of Nuclear War, International Scientific Synposium, World Cury=5s of Cardiology, Washington, D.C., September.
.,r*.
j
- .9_;
. Teaching Experience'(Continued):
1906 (Continued) ~ ACIS Certification course for HCEP physicians, October.
Iacture on Disaster Mar.;, R.,'BWH emargency conferenos, October.
Imeture'en Nuclear Disasters and the View frun
' CT-A.2Ffl, New England Medical Center, -
Novuuber.
Iacture on the C 4ifl Disastar, seminar for PSR speakers, . Boston, nanamhnr. ,
1987 Delegate, Internatica1al Peace Forun, as guest of the Soviet Acadany of Medical Sciences, Moscow,-
February.
Plenary lecture on Systems Failures in Disaster and seminar leader mi Civil ~ Defense Issues, PSR Annual Meeting,. Chicago, Mards.
ACIS Certificatimt course for HCHP physicians, Mardt.
Iactures an Biological Effects of Radiation in War:
and Civil Defense for Disasters and Nuclear
. War, Harvard Medical School Course on Health Aspects of Nuclear War, March and April.
Iacture on History of U.S. Civil Defense and .
Disaster PlannirxJ, Brown University Medical' Sduaol course cm Nuclear War, Providence, RI, April.
Iacture on DecisierH6aking Under Stress:'
A Perspective on Disasters, Harvard Club of Bastat Spring Lacture Series, April.
ACIS certification course for IMH house officers, Boston, Juna.
Consultant to the commonwealth of Mammam.atts, on emergency medical plannirxJ for Seabrook rnaclear power plant, Boston, August-September.
Seminar en Decision-Making Under Stress case study of Philadelphia MNE action Harvard l Tratsma Study Group,: Boston,- Septenber.
1988 Consultant to the 'Ihree Mile Islami Public Health Advisory Fund on amargency medical planning for 'Ihres Mile Island rmaclear power plant, Basten and Philadelphia, January - Ocenhar.
Field investigator with delegation frun Physicians for Human Rights, Israel, West Bank, and Gaza, February.
Panelist an Trauma in the occupied 'Isrritories Harvard Medical Sdiool, Boston, February.
Keynote speaker, 'Iha Illusion of SDI, Annual Meeting of ihysicians for Social Responsibility, California, March.
Medical Grand Rounds,'Ihe Medical consequences of Nuclear War, Sutter Health, Sacramento, April.
1 I
L (
L Teaching Experience (Continued):
1988 (Continued) Guait lecture, Triage and Nuclear War, Sacramento Chapter of R1ysicians for Social Responsibility, Sacramento, April.
Iacture en civil Defense, Harvard Medical School course on Nuclear War, Boston, April.
Iacture, Medical Implications of the Uprising in the Comqp Boston, Apru,ied Territories, Fannedy School, Iactures, Civu Defense and Nuclear War, seminar for regional civil defense officials, Federal Dnergency Management Agency, Etsnittsburg, MD, May and June.
Iacture, Miat if Nuclear War nnan, Cambridge Forum, Cambridge, May.
Seninar on Medical Consequences of Nuclear War, University of Maanw+nasetts at Boston, study series for high scnool teachers, Boston, May.
Lecture en Irt=wiate ard Iong-Term consequences of Nuclear War, EiWith Congress of International Physicians for the Prevention of Nuclear War, Montreal, June.
Imeture, In Dreams Begin Responsibilities, Imeture Series, Boston University, Boston, October.
Acts certification course for HmP physicians, Boston, October.
Panelist on the Casprehensive Test Ban Treaty, Space Bridge course between Iufts University ard Mnar= State University, Boston, October.
Iacture on Medical Ethics in Eii-up.y Practice, American Medical Students Association Annual Meeting, Boston, October.
Lecture, Systamatic Trauen in the Occupied Territories, Panel en Human Rights Violations, American Public Health Association Annual Meeting, Boston, November.
Principal clinical and Hospital Service Responsibilities:
1977-1978 Eimiupcy Physician, Harringtcs1 Memorial Hospital Southbridge, m.
- Emergency R1ysician, Wing Memorial Hospital, Palmar, M .
ans. ician, Imell General Hospital, Staff Physician, Bunkar Hill Health Center, charlestown, m.
Staff Physician, Ambulatory Screening clinic, Manaae+nasetts General Hospital, Boston, E.
1978-1982, 1983-1984 Eihiup. y Staff Physician, Mount Auburn Hospital, Cambridge, E.
W i ;tU Principal Clinical and Hospital Service Resperisibilities (Continued):
1982-1983 hwcf Staff Physician, Newton-Wellesley Hospital and Carney Hospital.
1984- Chief of- Emargency Services, Harvard Comunity Health Plan.
1986- Emergency Staff Miysician, H3P Emergency Service at Bri Attending $h am e yand c Wcuen'sBrigham Physician, Hcspital.and Women's Hospital.
1988- Pial Assistant to the Medical' Director, Harvard Ocasunity Health Plan.
Bibliugoptry:
Reviews:
Link JL. Jaview of the Wtaan Patient: Volume I, Notaan Mr and Nadelson CC, eds. Soc Sci and Med. 1979: 13A:830-831.
Laaning J. Review of MO Report, Effects of Nuclear War on Health and Health Services, Envirarisontal Inspect Assessment Review 1986: 9:99-103.
Videotape: -
Link JL. Eiierupcy Mrar= , it of Asthma. 1978: Maamar+1usetts General Hospital E m p cy Videotape Series.-
Imgal Briefs:
Principal author of sectics) to Supreme Judicial Court for the Commonwealth of Maaaachusetts, Moe v. Hanley, No. 2231. Amici Curiae. September, 1980.
Publications:
Executive Ocamittee, Riysicians for Social Responsibility, Medical Care in Modern Warfare, NE3M 306:741-3, principal author.
- Imaning J. Civil Defense in the Nuclear Age, 'Destimony presented to the Ccmunittee on Ptittign Relatimis, U.S. Senate, Record of Hearings on U.S.
and Soviet Civil Defense Programs, March 16 and 31, 1982.
J. European Civil Defense Planning, 'Destimony presented to the House i@t Otannittee, S*rwnittee an Envim_,t, Energh and-Natural Resources, U.S. House of Representatives, Record of Hee. rings, April 22, 1982.
Imaning J. Civil Defense in the Nuclear Age: mat Purpose Does it Serve and mat Survival Does It Prmin=?, published and distributed by PSR, Cambridge, 1982.
_- - - - - _ - - - - - - - l
4 i -
Biblivganiif (Continued):
Publications (Continued):
Link JL. Emrgency Response to Nuclear Accident / Attack. Prrv'aadings of the Second World Cangass on Emergency and Disaster Medicine, Pittsburgh, PA, June, 1981.
Isaning J, Leighton M. The World According to FEMA: Preparing to Survive Nuclear War. Bull. Atorn. Scientists, 1983:39:
Imaning J, Yayes L, eds. The Counterfeit Ark: Crisis Relocation for Nuclear War Ballinger, Cambridge, MA, 1984.
Isaning J. Civil Defense Planning for Nuclear War. C Manni, SI Magalini, eds. Disaster Medicine. Springer Verlag, New York, 1985.
I.eaning J, Imaf A. Public Health Aspects of Nuclear War. Ann. Re/. Health 1986:7:411-39.
Isaning J. Burn and Blast Casualties: Triage in Nuclear War. F Solomon, RQ Marston, eds. The Medical Inplicaticris of Nuclear War. Institute of Medicine, National Arwkuny Press, Washington, D.C.,1986.
Isaning J. Analysis of Current Civil Defense Plan. Testim,rly presented to the House Armed Services Sith ittee on Military Installations and Facilities. U.S. House of Representatives, Record of Hearings, March 27, 1987.
Geiger J, Isaning J. Nuclear Winter and the Irnger Ibrm s Consequences of Nuclear War. Prev. Med. 1987:16:308-18.
Isaning J. The HNA Civil Defense Prugam, Bull. Atom. Scientists 1987:43:42-46.
Daley W, Imaning J, Braen R.190 Telephone Triage and Emergency Medicine. J. Emerg. Med 1988:6:333-338.
Isaning J. Physicians, Triage, and Nuclear War. I.ancet 1988:8605 269-270.
U:n N 4 M Reports:
Link JL. Evaluation of Pre-7bst Population Questionnaire administered in rural Taiwan. U.S. Agency fro International Development, September,1969.
Link JL, et al. The Mid-South Health Plan. Report to the Board of Directors of the Mid-Southside Health Planning Organization and to the Office of Economic Opportunity, Chicago,1971.
Link JL. Report of Site Visit to Salem Hospital Eaupcy Service, Submitted to Salem Hospital Board of Directors, February, 1978.
1
'6 Bibli+=t i,f (Contimed):
Urgublished Reports (Continued): .
Link JL, et al. Position Paper of R:ysicians for Social-Respcmsibility on the Civilian Military Contingency Hospital Systen. Physicians for Social <
Responsibility, Cambrickye, MA, October,1981.
Daley W, Imaning J, et al. Bnergency Telephone Triage Manual, Harvard n =mw11ty Health Plan Emergency Servloe, 1986.
Imaning J. Health Consequences of Radiation W we and Issues of E-pcy Evacuation, Report for the Attorney General, n=nmwealth of Mansw+:usetts, 1987..
Imaning J. Issues of Emma.pcy Medical PlannirxJ. Report for the Three Mile Island Public Health Mvisory Fund, M111adelphia,1988.
Geiger }LT, Ieaning J, Shapiro L, Sine % numm1 ties of Conflict: Report on the Medical Fact-Finding Mission to West Bank and Gaza. Physicians for Human Rights. Boston, 1988.
In Preparation:
Weiss X, laaning J, Goldman P. Emma.p ay Room Patient Transfers: An Evaluation of Ambulance Records as a Source for Surveillance Data.
Submitted to Health Services Researdt, October,1988.
Imanirs J. Planning for the Treatment of Casualties After Nuclear War:
An Analysis of the 1988 ER Report. Sutanitted to the Br Med J, November, 1988.
Imaning J, Weiss K. Patient: Transfers Between Emergart:y Rooms in the Greater Boston Area. Tb be sukanitted fall 1988.
Leaning J, Gerhart T, Yett H, Livingston W, Hayes WC. Medical Complications of Hip Fracture :. A Review of 210 Patients with Femoral Neck Fracture. Tb be tted fall 1988.
Leaning J, Gerhart T, Yatt H, Livia.pL:ri W, Hayes WC. Dwell Time for Hip Fracture: Measuring Quality of Care. 'Ib be submitted fall 1988.
4