>> John Dowd: The Middlesex County Office
of Health Services has made radiation emergency preparedness
a priority since 2008.
By exercising with, and providing education programs
for first responders, volunteer groups, and the public,
we've built strong partnerships within our community
that are critical for radiation emergency response.
My name is John Dowd.
>> Rich Kozub: and I'm Rich Kozub - and together we have
over 60 years of local public health emergency experience here
at Middlesex County Office of Health Services.
>> John Dowd: In 2008 our county developed an emergency response
plan for a radiological dispersal device.
After the plan was put into place, we designed
and provided training for county staff and volunteers.
>> Rich Kozub: We first met the Centers for Disease Control
and Prevention's radiation emergency preparedness team,
at a Medical Reserve Corps conference in Dallas, TX,
in 2011, when Dr. Ansari and others
from CDC presented the Community Reception Center,
or CRC concept to everyone.
The big question that came up at the conference was:
"Is this the role of public health?"
While we had been working on the idea of radiation monitoring,
it was after we spoke with the CDC about the CRC concept
and how one would flow, that we found a template
for moving forward.
In particular, concepts taken from CDC's Population Monitoring
in Radiation Emergencies Guide assisted us in the development
of our response plans and procedures.
It was after that conference that we had
to answer a critical question: "Who's responsible
for CRCs in our community?"
We knew we'd have to be ready to set
up CRCs during a radiation emergency,
and because of the location, size and scale
of Middlesex County, we knew training
and partnerships were an essential part of that plan.
We decided to plan a regional CRC functional exercise,
and that meant additional training and continuing
to grow our relationships
within the radiation preparedness community.
>> John Dowd: Our training ramped up in 2009
after we received funding
from the Urban Area Security Initiative
of Northern New Jersey
to purchase equipment for the program.
During that time, our county sent nearly 100 individuals
to classes at the Department
of Energy's Counterterrorism Operations Support Center
in Nevada.
From there, we applied that training through a number
of table-top and functional exercises with other local,
state, and federal preparedness agencies.
Prior to Gotham Shield 2017, our Office had participated
in over six radiation training exercises.
That participation was critical for us to see how our plans
and procedures played out in a simulated event,
and to clarify other agencies' responsibilities
and capabilities, and how we would work together.
>> Rich Kozub: Partnerships have been as essential
as training throughout all of this.
After each exercise, we grew our partner network
and included them in future exercise plans.
Working with other agencies
on development has never really stopped.
I'm on the phone with different federal agencies almost every
other day, and that just continues year after year.
Answering questions like: "How do our roles fit together?
How can we support others?
And, who's supporting us?"
>> John Dowd: When we participated
in the Gotham Shield exercise, all the partnerships
and individuals we met over the years came full circle.
We had over 70 different agencies participate
in the CRC portion of the exercise,
from federal all the way down to local.
Gotham Shield provided us the opportunity
to include additional agencies in the exercise process.
This reinforced to us the volume of staff and volunteers needed
to manage an event of this scale.
It also provided us the opportunity
to develop just-in-time training materials and job aids
to support staff at the CRC stations.
The experience provided lessons learned in many areas:
improving triage, teaming health physicists
with mental health professionals, and the need
for message coordination between New Jersey and New York.
Like every exercise, Gotham Shield helped us
to further enhance our partnerships
and overall preparedness.
And with the support of our Freeholders,
the county legislators, we are using
that momentum in constructive ways.
Going forward, we are working specifically
with our local hospitals, access and functional needs groups,
mental health specialists, and health physicists.
Our goal is to ensure that all staff are trained for their role
in a radiation emergency, and to ensure we can do our part
to help hospitals maintain a manageable patient volume.
Part of that effort means paying close attention to,
and ensuring we can support, individuals with access
and functional needs,
and integrating our County Animal Response Team
to help manage individuals who arrive at CRCs
with service animals or pets.
The CDC has always been one of the top sources
to access fact sheets and power point slides for our trainings
on radiation emergencies.
In fact, we've incorporated many of their online training modules
into our awareness-level training
for our staff and volunteers.
Another excellent resource is the CDC's CRC Toolkit.
The toolkit provides relevant resources that enable planners
to create an entire exercise.
>> Rich Kozub: We've also used and adapted CDC's CRC Flowchart
to increase the volume of people that we can help at an event.
We modified it to integrate basic registration steps
into our waiting lines, and the CDC was interested
in how those changes would impact participant throughput
times - how long it takes a person to go
through the stages of a CRC process.
Testing throughput times at exercises is a great way
to measure and build models
for predicting how a CRC should scale
to accommodate the large number of people we'd expect
in a radiation emergency.
Using this data, CDC can build electronic tools
that help others optimize their CRC operations.
The CDC found that our modified flowchart did make things go
faster for people who didn't have to go
through a full dose assessment.
Since we also used actors in our exercise, we were able to begin
to measure the timing impact of concerned individuals
who may need more time to talk with radiation
and mental health professionals.
Over time, we've expanded who we work with at CDC
to include the Inorganic
and Radiation Analytical Toxicology Branch
for dose assessment and sample processing questions,
and also the Office for Public Health Preparedness and Response
for planning and policy topics.
>> Freeholder Director Ronald Rios: I am most impressed
with how our Offices all work together,
especially the Office of Health Services.
You need to have county offices, the state,
the federal government, and our municipal partners working
and preparing together so that we maintain the highest level
of effectiveness possible.
At all times, you need a dedicated and hard-working staff
who have put in a lot of hours to get to where we are today,
and I am so proud that we have that here in Middlesex County.
>> Freeholder Chairperson Shanti Narra: To us, success is built
on the team that comes together to do all this -
county personnel, volunteers, and our public health partners.
After a big exercise like Gotham Shield, I see our impact
when people who don't have any radiation training come in
and say, "Wow, this exercise was great.
Thank you so much."
They have seen what radiation emergency response requires;
they have applied their skills; and they are better prepared
to perform their role within the overall team.