Discussion Guide for Decision-making

Overview

Decision-making in radiation response

A large-scale radiation emergency will require a significant number of public health, medical, environmental, and other professionals to support a federal, state, tribal, local, and territorial (STLT) response.

Such a response will be complex and will require extensive collaboration and coordination among multiple departments and agencies. It will demand an ability to critically think about—and make difficult decisions regarding—public health protection, population movement, medical care and screening services.

Responders will also need to consider logistical challenges regarding food, water, communications, and hazardous materials. To adequately prepare for this need, public health and emergency response organizations have made training and retaining their response workforce an ongoing priority.

Addressing a need

Over the past decade, CDC has provided several resources on radiation emergency preparedness topics. However, responders still need resources that can help them synthesize information to appropriately manage discussions and decisions during a radiation emergency. To address this need, CDC developed the Discussion Guide for Public Health Decision-making in a Nuclear/Radiological Response.

What is a discussion guide?

A discussion guide provides questions to prompt or facilitate a gap analysis of a topic area. This discussion guide follows a facilitated process to help answer questions related to the role of public health agencies in decision-making during a nuclear or radiological emergency. The guide helps identify the who, what, when, how, and where:

• Who will ultimately make this decision and WHAT information and recommendations does the decision maker need?
• Who is responsible for providing recommendation(s) to support the decision?
• What information do decision makers need to make an informed decision? WHO can provide that information?
• When do you need the information?
• How do you get this information?
• Who is responsible for the ultimate decision?
• Who has the expertise in this area?

Responders can use the components of this guide in discussion-based exercises and training.

Assumptions

• A no-notice nuclear/radiological emergency has occurred in a U.S. city and is a potential threat to the jurisdiction using the Discussion Guide.
• The activity coordinator or the designated facilitator (see Planning Team section) has more than a basic knowledge of nuclear/radiological preparedness concepts.
• People participating in the discussion may not be the decision makers, but they will have a role in supporting decision-making in an actual nuclear/radiological emergency.

Considerations

• This guide is a starting point for discussing public health agencies' role in decision-making during a nuclear or radiological emergency. It is just one of many tools available from CDC and other partners.
• The scenarios and questions in the guide do not address all key issues associated with decision-making during a nuclear or radiological emergency. However, they can help to identify the key issues for a jurisdiction and the role of public health agencies.
• The usefulness of the information gathered depends on the partners involved in the discussion and how you structure your activity. For a more robust discussion, invite decision makers or key personnel from partner agencies (e.g., emergency management, radiation control) with a role in supporting decision-making in a nuclear or radiological emergency. This does not mean there is no place for discussions involving only a public health agency's staff, especially if they lack expertise in nuclear and radiological emergencies. This guide can support a variety of discussion activity settings.

Goal and objectives

Goal

The goal is to aid preparedness and response professionals in discussing public health decision-making in a nuclear/radiological response.

Main objective

The main objective of this guide is to provide probing questions that promote critical thinking about the role of public health agencies and other partners in supporting decision-making in a nuclear or radiological emergency.

Supporting objectives

• Discuss public health responsibilities related to a nuclear/radiological response.
• Identify key public health decisions in a nuclear/radiological response.
• Identify resources to support public health decision-making in a nuclear/radiological response.
• Develop capacity to make key public health decisions in a nuclear/radiological response.
• Identify and recognize the role of partner agencies in a nuclear/radiological response.

Intended audience

Using the discussion guide

The intended audience for this discussion guide is the people who will plan and facilitate discussion-based activities (see Planning Team section). This guide and the Resources for Nuclear-Radiation Emergency Planners support creating activities that strengthen public health decision-making in a nuclear or radiological emergency.

Participating in a discussion-based activity

The intended audience for the discussion-based activity is STLT emergency response professionals who may need to make decisions or support decision-making in a nuclear or radiological emergency. In these types of emergencies, public health agencies must think critically and make difficult decisions. These decisions often require input from subject matter experts (SMEs) and other partners in the community or jurisdiction.

Discussion focus

It is important that participants understand that the overall focus of the discussion is on public health decision-making, which may include decisions related to certain topics:

• Public health protection (e.g., responder safety and health, protecting the public's health)
• Population movement
• Medical care and screening services
• The public health impact of disruptions in providing food and water
• Timely communications about exposure to hazardous materials

Because of this public health focus, there may be times during the discussion when some participants—representing their agency or organization—may not need to engage. However, other discussion topics might heavily involve their agency or subject matter expertise. For example, a medical subject matter expert (SME) could have different roles:

• No role or minimal role when discussing food transportation logistics.
• A light role when informing communication SMEs addressing the public.
• A heavy role when managing medical triage expectations.

Variability is okay. Not all partners will fully participate in every topic or be invited to every discussion.

Instructions

Planners can use this discussion guide to develop discussion-based activities related to public health decision-making in a nuclear/radiological emergency. Ideally, activities will involve a small participant group.

Facilitators can conduct discussions in person at a predetermined location, by e-mail, or virtually using technologies, such as Teams, WebEx, or Zoom. They can also organize discussions in a hybrid form that combines these methods.

Discussion options and length

Discussion-based activities tend to be informal, 1- to 2-hour-long, brown-bag-like activities for small groups. However, planners may also choose to create many different types of discussion-based activities, such as the following:

• An in-person discussion with public health staff focused on a specific planning gap identified.
• An e-mail discussion gathering responses to specific discussion questions from different agencies to determine gaps and incongruities in planning.
• A virtual meeting series where participants discuss several capabilities over the course of several weeks or months.
• A 5-hour in-person discussion activity (e.g., workshop) covering a specific response function with partner agencies.

Participants don't need to answer all questions in one activity. Discussion prompts focus on the who, what, when, how, and where. Here are some things to consider:

• Sharing the discussion information beforehand has two benefits:
  • Participants will come in ready to talk about the issues. Preparation may help decrease the length of the activity.
  • You can use an online format (e.g., Google Docs, SharePoint) to collect participants' answers prior to the session so that you can more easily share them with the group as a starting point for the discussion. This may be particularly beneficial for identifying inconsistencies in plans.
• The activity does not have to be limited to just one session. The coordinator may choose to conduct more than one session to cover more situations and discussion questions.

Planning team

In organizing the discussion-based activity, you may need to form a planning team. Members of the team must be people committed to open communication with all response partners during a defined period of work (e.g., 3–6 months).

Team members can represent the partners that would make public health decisions or support public health decision-making. The planning team should include the following:

• Coordinator
• Facilitator
• Subject matter expert
• Note taker
• Other response partners

Whether you decide to have a formal planning team, a notetaker is essential to any discussion-based activity you organize. Notetakers are key to capturing information, insights, areas for improvement, and follow-up actions during the discussion. The Facilitator Resources section discusses the planning team in more detail.

Before the discussion

There are several tasks the coordinator should complete prior to the group activity.

Set participant expectations

One key task is to make sure that participants understand why they are participating and what facilitators expect of them. The Facilitator Resources section provides a brief explanation that facilitators can send to participants prior to the activity or distribute at the start.

Consider adapting this example for your own needs. For example, should participants understand or know their role during a nuclear/radiological emergency prior to the discussion? Will this be part of the intended outcome(s) of the activity?

Provide a primer to those who need it

Participants who are unfamiliar with nuclear or radiological emergency concepts and terms can consult the Primer on Nuclear/Radiological Preparedness and Response Basics.

After the discussion

As a last step, the coordinator (or a designee) should document what took place. This does not have to be a formal, written after-action report. It just needs to be a short narrative that covers these points:

• Who participated, their roles, and the agency/organization they represented
• The scenario selected for discussion
• The main takeaways from the discussion, including lessons learned and preparedness planning gaps identified

Once complete, the planning team can share this narrative with the participants and other pertinent people.