7.
Establish the ideal objectives
pens
a Screening:
Lhrt pathologic findings are sought?
{\* Thyroid + Hypofunction and/or
iwoplasia - adenoma or carcinoma
{BB} Breast CA (C) Skin CA
Il.
eetr ee
“D) Hematologic-leukemia, myelo-
Constraints
Present levels of cate
we.
ee
Screening: (1)(7) (9) (10) (11)*
Treatment: (4} - BNL currently treats
radiation induced problems at BNL and
Cleveland with good results.
+) establish a cause > effect
relationship ta genetic abnornetkicies}) (per Dr. J. Neel}.
Existing Policy
(1) (4) (5) (6) (7) (8) (9) (LO) * OA common
point of contact does not exist for all of
the agencies effecting or effected by the
BNL medical program.
Treatment:
4, Shore-term whatever treatment
: indicated to ¢tabilize the
-atdeat until he can be safely
transported to a designated
tertiary care center for
definitive therapy.
1%} Long-term therapy directed
cawards the pathologic con—dition(s} found at screening
oc by tertiary care.
3. Follow up:
(A) Short-term periodic re-
evaluation of any detected
abnormalities to determine
their status,
e.g.,
progression
vs remission.
(8) Long-terin: fixed protocol to
follow certiary/post operative
Existing needsanddemands
(45 (5) (6) (7) (8) (9) (1G) (1.1) * No unique
constraints for Option A.
Projected needs and demands
(2) (3) (4) (5) (6) (7) (3) (99 (10) (LI)* - Opecton
A offers the minimum needs and dezands but
will not meet the Marshallese <xpectatfons.
4
ee
constraint.
“anpower ()(3) (4) 65) (7) (11) * - Option A offers lowest requirements.
However,
However, a cucback
in the level of care provided will provoke lack of cooperation by the Marshallese resulcing
iq poor cooperation, compliance + wasted time, poor data.
timing - (2)(3)(4)(7)* - Marshallese claim injury due to long-term Exposure to “low level"
radiation. Recent U.S. "low level" studies and fear of long term effects hes strengthened
“airshallese position. Bikini episode - media.
direct
Demographic Population Characteristics ( 4) (7) (8) (9) (10)* - The culture prohibits
U.S. efleres to clarify
must be used.
A mediator
2. Rerform
:
follow-up. DOE best suited to
identify single contace sinc.
Our cut-be
“Flexibilit
Where: Screaning of axposed
Thies opt
and controi populations whereever we can locate them.
When: [ining should 3:e based
upon the best availasl
know
ledge regarding the tiue i-ter- r Avoidance
val for the detectio1 of r.dia- be With str
pupalid data
tion abnormalities.
foncentrat
Mlution o
How: The BNL medica] team is
eduction
cutrently doing considerab +
cational program would be
medical program was bei:tg
reduced at this time. The
Timirs
The timing of the BNL field surveys
is of great importance for the
following reasons: 1) Long lead time
must be included to insure prope >
notification of the study group —
(especially on the outer islands - we
movement to "free a. 30cia~
tion” will probably .27oro7.i+e
the already inadequate heaicth
care funding by tha Trust
Territory.
must always keep in mind the poor communications);2) Long lead time and a
fixed schedule will do much toe counter
the charges that BNL has planned its
trips to the outer islands to coincide
with the absence of many of the leaders;
3) Evenly spaced visits, about 24 months
apart wil] assist the BNL field staft in
A det:
i, Total cost
‘, The tote
“ The reduct
. the cost ¢
more than studying radiation
related pathology.
4 well-~
planned, high intensity edu-
mary referral system is almost an a>solute
he costs of Litigation brought by the Marshallese tor compensation could resule in
aignificant incr2ase in U.S. payments,
for screening, treatient and
'
oo
“(7 GY) (7) (8)* - option A will require the lowes: operating budget, isitially.
Who:
BNL medical teuin has 25
years of experience ‘nOptior.A
necessary to explain why the
—~€7) (8)(9) (10) (1i)* ~ The lack of a viable pri-
Fi: wncial
;
attaining the objectives, with Aa related
_ the hisi
each approach being stated in
terms of:
4 the enrli
What:
Screening(prinary de* document |
tecticn), Treatment--hort-cerm,
condition
., 8ppropriat
Follow-up,short § loiug~-term,
Single contact point fer effiassured b)
oe
cient coordination o° above.
An additional objective would be
to establish a single contact point
in DOE to coordinate all these pro-grams and to establish close liaison
with DOc & DOL.
In addition, since
the logistics, e.g., transportacion
is a common probiem to allusers,
there should be at least one
ariual users meeting with addit:onal
meotings as necessary.
officials. The resulting conlusicn has placed
the U.S. in a vulnerable position - ? credibility
Existing Facilities
Analysig
pron
Set fo:
Develop possibleapproachestoj}. medical
-
Planning at other levels
(1) (29 (3) (5) (6) (7) (8) * - The lack of coordination/liaison among the many laboratories
and governmental agencies invilved in Lie
care of the Marshallese has resulted in conflicting information from som2 concerned U.S.
eases for the rest of their
lives.
.spression of hostility toward another.
arievanees uisuccesstul to date.
TV.
‘| fhe relative constraints would
aot materially change the basic
objectives of Option A.
An additional objective has been zenerated
oy the idencification of a Lack of
coordination among the various
agencles and labs involved in the
total care of the Marshallese
Follow-up: (2) (4) (8) (9) (10) (11) (12)4
Our resident MD can easily follow up the
treated cases but not zeneral primary care.
2.
|
_ £11. Translation
teinstatement of refined
wbjectives in consideration
‘of restraints.
fibrosis, aplastic anemia, {E)
Cl tract CA (F) Genetic abnor-
calities (sample size too small
el
Ss
rn
OPTLO::A
*... detection and treatment of radiation related pathology in exposed
end control populations
*eNote:
Numbers under constraints refer
to common constraints, text p. 2-4
the rollov-up of che pathologic condicion:
Tee., Go relatively Eived cine base line
eno77?75
35
f'
|
The risk
medical ca
program of
” lack of pa
‘public pro
‘program fo
of care. R
other than
bidity and
Possible a
in a break
Cost /effec
effecciven
it very di
accurate ¢
If such da
un 2OaLs ¢
be derived