Throughout the United States, acts of terror are occurring more frequently and the substances used are increasing in variety. Many communities have experienced some terroristic threat or activity in the past few years. It is only a matter of time before a device with real or suspected radioactivity could be employed. In addition, radiological material is often transported via train or highway, with the potential of an accidental spillage.
Screening for Exposure: Why We're Needed
Immediately after the 1995 Sarin gas incident in Japan, emergency rooms were overrun with more than 5,500 people, the majority of whom were classified as the "worried well" – people concerned that they could have been exposed although they were not in the immediate area of the event. This severely compromised the care and attention needed by the actual critical patients.
Since that time, emergency authorities have attempted to plan for that contingency. Fear of the unknown can greatly affect individuals and populations. Acknowledging those facts and allowing concerned, but not critical individuals to be processed and notified of any subsequent developments addresses that fear, and can also provide health authorities validation of scope and containment.
In an ideal response after a radiological "event," there should be a designated location for the obviously exposed individuals to gather for evaluation, decontamination and treatment. However, there should also be separate locations those who are concerned, but were not in the immediate vicinity of the incident, can go for screening and education.
Arkansas DCs Identified as Candidates for the Job
In its emergency response planning, the need for the state of Arkansas to have a team of trained individuals, knowledgeable about radiation and equipment to serve at those screening locations was determined; and a unique opportunity recently presented itself for Arkansas chiropractic physicians to participate in a joint effort with the Arkansas Department of Health and the Department of Emergency Management.
The Arkansas Medical Reserve Corps held a meeting to explore how to acquire the best candidates for a team of responders to serve as screeners for radiological exposure. After much discussion, it was decided DCs were uniquely qualified to be the first health profession in the state to be so designated and to receive this education.
Chiropractic physicians already have background in radiation physics and have a respect for, but not a fear of, radiation. They are located in all areas of the state. They have a sensitivity to the public's concerns and can interpret test results in layman's terms. Furthermore, during an incident, DCs would not be committed to serving in hospital emergency departments or as first responders in the field. They are ideally suited to screen low-risk individuals and provide reassurance and education, or in the case of a rare positive reading, arrange for decontamination.
The Arkansas Chiropractic Physicians Association offered to host the information exchange and educational session for interested doctors. Seven members from the state's emergency planning committee presented the background, team concept and equipment usage. This was the course description:
Introduction to Radiation Detection & Population Monitoring
This course will provide an overview of radiological threats (natural, technological, and intentional), types of ionizing radiation, initial response roles, and multiple detection methods. The course will include didactic and tactile demonstrations of concepts to include the use of various radiological detectors and dosimetry. Emphasis will be placed on detection technique, use of initial and secondary monitoring equipment, and PPE requirements. Additional didactic areas will include exposure levels, decontamination, reception center operations, and consequence management. The course will be conducted by ADH Health Physicists and Emergency Response staff.
Participating doctors were trained in the use of a simple device, similar to a Geiger counter, as well as a pass-through portal, reminiscent of a TSA gateway, that can detect traces of radioactivity. Since their charge will be screening of those who are out of the immediate vicinity of a radiation incident, but fearful of exposure, they also reviewed the forms and recording that could allow follow-up with those individuals and tracking by the state health authorities. Contact information for those physicians was gathered for team rostering.
In the event of a radiological incident, team members will receive notice regarding the type of event and the screening location, and will have the ability to respond. Equipment will be provided by the state and assembled at the assigned site.
This educational session provided an excellent opportunity to work with the state for a preparedness function in an interprofessional arena. As with any type of emergency training, it is hoped that there will not be a significant need for this service, but it is recognized to be a component of state planning and demonstrated the chiropractic profession's willingness to cooperate for the benefit of citizens.
This also offers the potential for further dialogue with state officials and involvement in other public health programs. That doctors of chiropractic were selected to form this initial team for a necessary public service is a testament to the positive outcomes possible from dialogue and cooperation.
Author's Note: If you have questions about this project or about the involvement of the chiropractic profession in Medical Reserve Corps activities, please contact me at
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Dr. Karen Konarski-Hart's dedication to chiropractic and public health through the years includes serving as a governor's appointee to the Arkansas Board of Health (and the first DC to serve as its president), an ACA state delegate, a member of both the American Public Health Association (APHA) and the Arkansas Bioterrorism Advisory Committee, and president of the Arkansas Chiropractic Association.