On the cover of this journal supplement is a picture from the response to the Fukushima-Daiichi nuclear powerplant accident that began on March 11, 2011, the worst nuclear incident since the Chernobyl accident in 1986 (Figure 1). Coincidentally, in March of 2011, DMPHP published a journal supplement on Nuclear Preparedness.Reference Hatchett ¹

Figure 1.

A picture from the response to the Fukushima-Daiichi nuclear powerplant accident that began on March 11, 2011, the worst nuclear incident since the Chernobyl accident in 1986.

Norm and I led the work on the 2011 journal supplement. The premise for the supplement was that careful planning and having a clear understanding of how to fairly allocate resources can save lives in the worst case scenario, a 10KT nuclear detonation.Reference Coleman, Knebel and Hick ^{2 ,} Reference Knebel, Coleman and Cliffer ³ The main message was that “thoughtful planning is not futile and can substantially mitigate the health consequences of a nuclear attack.”Reference Coleman, Knebel and Lurie ⁴ Close on the heels of completing the 2011 supplement, Norm deployed to Tokyo to provide expert advice to the US Ambassador to Japan during the initial response to the Fukushima accident. Norm applied the concepts from the 2011 supplement to the Fukushima response and then published the lessons learned from his experiences.Reference Coleman ^{5 ,} Reference Colemen, Blumenthal and Casto ⁶ Through the remainder of his life, Norm and his vast network of colleagues continued to refine the practical solutions included in the 2011 supplement.

I had the privilege of working with Norm starting in 2004 when he volunteered to apply his extensive expertise in radiation oncology to our planning efforts in the office that is now known as the Administration for Strategic Preparedness and Response (ASPR). Between 2004 and the publication of the DMPHP supplement in 2011, Norm pioneered and championed a systems-based approach to radiological/nuclear medical response planning that included the development of practical tools and approaches. Just a few examples of these approaches include the RTR (Radiation TRiage, TReatment, and TRansport) systemReference Hrdina, Coleman and Bogucki ⁷ that delineates zones of damage that can be used to plan response activities (Figure 2), the online Radiation Emergency Medical Management (REMM) just-in-time system ⁸ that is a preparedness and response tool for the medical community (Figure 3), a state and local playbookReference Murrain-Hill, Colemen and Hick ⁹ to provide state and local planners a template to help them create their own radiological event response plans, and the concept of a user managed inventory to help ensure medical countermeasures can be delivered quickly and efficiently during a disaster to save lives.Reference DiCarlo, Maher and Hick ^{10 ,} Reference Coleman, Hrdina and Casagrande ¹¹

Figure 2.

Between 2004 and 2011, Dr. Coleman pioneered and championed a systems-based approach to radiological/nuclear medical response planning that included the development of practical tools and approaches such as the RTR (Radiation TRiage, TReatment, and TRansport) systemReference Hrdina, Coleman and Bogucki ⁷ that delineates zones of damage that can be used to plan response activities

Figure 3.

The online Radiation Emergency Medical Management (REMM) just-in-time system is another practical preparedness and response tool created for the medical community by Dr. Coleman. ⁸

Norm continually worked with colleagues to refine these ground-breaking concepts to improve their utility. One example is the concept of the Nuclear Incident Medical Enterprise (NIME) first published by Norm and colleagues in 2015Reference Coleman ¹² and then further refined in 2021.Reference DiCarlo, Homer and Coleman ¹³ The stated purpose of the NIME is to apply the best available science to the very complicated nuclear disaster response scenario while also keeping in mind the goal of answering the responders’ question: “what do I do now?!” (Figure 4). This concept is an elegant depiction of the systems-based approach that Norm championed and kept refining as our understanding of radiological/nuclear medical response grew.

Figure 4.

Dr. Coleman continually worked with colleagues to refine these ground-breaking nuclear preparedness concepts to improve their utility. For example, the concept of the Nuclear Incident Medical Enterprise (NIME) that was first published in 2015Reference Coleman ¹² and then further refined in 2021.Reference DiCarlo, Homer and Coleman ¹³ The NIME applies the best available science to the very complicated nuclear disaster response scenario while also keeping in mind the goal of answering the responders’ question: “what do I do now?!”. This concept is an elegant depiction of the systems-based approach that Dr. Coleman championed.

Another example of how Norm’s elegant and groundbreaking concepts were refined over time is the concept of the User Managed Inventory that moved away from procuring medical products for specific threats (e.g., a radiological event), and toward a paradigm that focuses on the clinical symptoms/conditions irrespective of the causative agent. The premise of this “cause agnostic” approach is that no matter whether the injury is caused by radiation or chemicals, the symptoms and pathology are the same so the same countermeasure can be used to treat the injury.Reference Rios, Garcia and Hogdahl ¹⁴ Such an approach allows for more cost-efficient procurement and distribution of medical countermeasures to make lifesaving medications available “just in time.”

A search of the Web of Science shows 57 of 292 manuscripts Norm authored were specifically about the effects of radiation (both positive and negative). Norm’s radiation-related publications have been cited nearly 2000 times. The influence of the 2011 supplement is reflected in the more than 500 citations of the 16 articles in that publication. This impressive body of work has had tremendous influence on the field of radiological disaster preparedness and response. It has changed the narrative from one of futility to one of concrete approaches to mitigate the health consequences of a radiological disaster.

The cover of the 2011 supplement showed a picture of the destruction following the bombing of Hiroshima. The commentary by Dr. Douple highlighted how the findings and lessons learned from the survivors of the Hiroshima and Nagasaki bombings informed the ground-breaking concepts and approaches to nuclear preparedness and response that were included in the 2011 Supplement.Reference Douple ¹⁵ In the same way, findings from the Fukushima disaster and the other evidence-based approaches that Norm championed (RTR system, REMM, the state and local playbooks, user-managed inventory, and others) remain relevant today and helped to inform the content of this supplemental issue of DMPHP.

This publication honors Norm by providing the latest thinking on how to maximize the public health and medical response to radiological disasters to save lives and provide the highest possible quality of care to the victims. Norm’s efforts throughout his life to refine the practical solutions he championed are recognized with posthumous authorship on several articles. Threats of radiological terrorism and nuclear reactor accidents remain real, but thanks to Dr. C. Norman Coleman, we no longer believe that planning is futile. We have practical tools and approaches that have been tested and prove that there are indeed things we can do. Norm had a relentless desire to make the world a better and safer place and his body of work demonstrates that he succeeded.