Currently, isotopes in the Alert software is limited to Co-60, Cs-137, I-131 and Ir-192. What if the isotope is unknown or known but not on the list?

The conversion data is only available for the isotopes in the list. As additional data becomes available, software will be updated. If the isotope is not on the list, the operator will need to use the MCA features to identify individuals with high count rates, and use onsite health physicist (HP) expertise to set count rates limits for follow up. Alternately, the HP may select an isotope from the list which has a similar response, and apply a correction factor or set the limit differently. Since the data is directly exportable to Excel, it is very easy to manipulate after collection.

How critical is the exact height and weight in performing exposure calculations?

Exact weight and height are not critical. The factors in the tables cover a BMI range, not individual values.

What limits should be set for screening levels?

Initially the recommendation for screening levels by the CDC was 5 x ALI (annual limit of intake), which was considered the CDL (clinical decision level). However, that number must also be based on screening criteria-e.g. screening 500 people vs. 5,000 may require a different limit. Also, there is a new guidance document which should be published soon which may change the limits, particularly for certain critical groups, e.g. children, pregnant women. The HP or public health expert overseeing the process will need to make those decisions.

If the scenario is a dirty bomb, should the assumption always be inhalation versus ingestion?

Inhalation is the most likely route and all of the data in the first release of the Alert software is based on inhalation. A software upgrade will be sent as soon as the ingestion data is available at no charge. The route and selection of inhalation/ingestion will require the expertise of the onsite HP overseeing the screening process, because it depends upon many variables, including environmental and human factors.

What assistance is available to help sites prepare an emergency plan?

The CDC guidance documents at the attached link. http://www.bt.cdc.gov/radiation/index.asp provides a great resource for planning and includes additional references for review. Additional assistance is available from local public health or emergency planning offices. Organizational structure and local facilities will vary from state to state; however, all will have some type of emergency response group. It is important that each facility become familiar with the organizational and communication protocols in place at their locale.