OPTION B n-relsted diseases plus the care Theu deteetion and treatment of radtactio found to and tvilow-up of patients fn the Ixposed and Control Groups have non+radyaucion relaced dlovdous lL. Establish the ideal objectives. A. Screening for rad{ation-related A pathologic conditions as in Option - plus additional screening for age diseases. apd sex correlated high risk BR Treatment as in Gption A for ridiation-related diseases. LLL. Translation Ti Constraints For all ry other diseases change "tertia ry care ceater to primary oF seconda caré center, as available. Follow-up (as {on Option A) Cc. primary or ~ Change tertiary care to le. secondary cure, gs avallab Present levels of care ~"Slyceaing: a8 In Option A - plus, need co develop “rok cables" (age and sex specific) to expand tie gcrceulng data base. The relative improvement in recent health “statistics” should be of some asutatance. Treatwenc: (1)(7)(9)(10)(11) plus tnereosed logistic requiremenra of added care. in consideration of restraints. each approach being stated in As in Option A - The increased patience care demanded by Option B What: terms of: Ag lu Option A = plug selected "risk hazard appraisal" acreening, care and follow-up. a Selection Critecta Set forth the criterta for the selection of am appeeach: Performunce or reaults As in Option A - However, Lhe section on radiation related diseases will amesct to be expanded co include chose age and sex specific general mdical problems hoc currently assocfated with radiacion. The methodology of KoLbins and Hall will be used co determine what specific historical, physical, und Jeboratory Findings would be most sensitive and specifte co detect the mest prevalence diseawes (age and sua-determined, c.g., we wild not luok Cor Lorem y Fo) lue-up: As in Option A - plus increased Yoylutic wand manpower required for care. Since the lacrease ia directly related to primary patient care Who; Euleting Policy As in Option A - plus current operacing proceduras already includes thia added group and athena. ponsibllity, perhaps some Inter agency agreemeot with DOT could be reached to provide thia supplement. In addition, if, under the active commitment. atherosclerosis ln young fewules, evidence for alcoholisa will be songhe in young und old mates, etc,), Where; Total kadeting needs and demands Kwajalein toxea are to paid directly cure Jaavident to many Marahallese. They are surceutly and have biscorically, demanded ether cite, portion might be diverted co grimary medical care under a DUU/Kwa)- Au in Uption A - The need for better primary Propectid needs and demands Au ja Uption A > plug an ever increasing base popul-tlen - erude geoweh rare 3% ~ better pri- mary sedicul cape will probably reduce mortality reoutitag fu increasing population. Many Marshallese arg wting for birch control education, Plansiay at other Levels Aa sa Option A = Plus significant decrease in abesegp maper T.T. support of medical care due tu vote tor “free association”. Pedeeing Pacdiicies Aw 1. Uption A - plus the increased load of futttor patlent care would strain the existing facbbitivs resulting in severely diminishing returns [ue +sh beslih dollar (below minimum “eritical Mase"). bh + cots (ECS) C6) {7)€8) The added screening costs will %s 2sanl) inctement in the existing screening plectss The added pelmary and secondary cure and {olla - both short/long term may be a aignifificant (See facilities cost the dis wasn atte tol and chere prevlance). anount (dependent upon as well). ett f cugperation wil) hopefully improve compl tance dia ~ A n Optio in Manpower: (13) As alos: requirements cun be handted by better The iu Cra bue t # Tang quality of dateay. Fees (ar Ajst, og nurse praccitioner. wer, add fay ome utilization of manpo tie tool oon cage should raise credibilicy of DOE/DOI. er, Ilowev ~ A AS in Option Timing: teh oe procedures! w This option 4s stil} belo dath‘elu Uptiva A - but with « reduction in covert Pemopraphic Popu Locion Chart t Y ,oedenumler care, scfiil below, currear tion. hoseLbity + increased coopera operating palictes. mt attaining the objectives, with will require a slight increase in manpower and logistics (Funding). V. Analysis iv. Develop possible approaches tu Restatement of refined objectives and {s, therefore, nat DOE's res- “Cros association” agreemenc che DODto the Marshall Islands, some fixed Marshall tsland Government agreement - As in Option A - BNL is currently excceding Option B in its Screening, care and follow-up of exposed and control groups wherever ve can locate then. When: Ags in Option A ~ plus regulac intermittene visits {every 2'5 months) Eor follow up Of nun-radiaclon related problems (already being done). How: We would, uctually, need to cuc back on our present commitments to comply with Option 8, e.g., we have aiready puc almost oll of the people formerly on BLlkini through che entire scresuing procedure. As in Option A -but we cun cancel out che specific education program (explaining che cut in services). The various cost trade-offs have been discussed in che previous sections of thls option. We mur keep in mind That this option is acil) below our present commitment. Flexibility There is Increased fleathility with this opefon, We feel che #NL team Stationed at Ebeye could handle thts additonal Josd without prubtemsy in Fact, it would enrich their practice and provide some vetcome warloty. Avatdance of untoward consequences The added flexibiiley and commitment of the DOE/BNL cess shauld enhance ar shaky credibilicy and yenerace true gratitude among sume ot the Murtnalles The critical point ia never to promise more chan you can dviiver. The ceedibility pap may be partially putched by saying "To dun'c knaw” more feequentky and by forwarding all pertinence daca on to facsrested Marshalle as soon as if 1s avalluble. Risk The riska to DOE/BNL are Lesa than with Option A - However, Lhis level on effore is below the current program and will cause some adverse reaction (publicity, cooperation, erc.}. The ciska co the Marshallese are thac a great deal of potentially treatabl- disease will be excluded From our atteatlun by this optiay, Costfeffectiveness As in Option A Timing As in Option A - The increased population would nor appeectably change our existing schedyle.