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Effective response requires the performance of several basic functions: emergency command and control, notification and communication systems for responders and the public, emergency assessment, mitigation of hazardous conditions, and protective actions for emergency responders and the public.1 These words from the National Council on Radiation Protection and Measurements highlight the consequence management challenges responders face every day. The addition of radiological contamination from a Radiological Dispersion Device (RDD) significantly complicates these challenges and raises the stakes in terms of risk to emergency responders themselves and to the public at large. This paper will discuss and analyze these challenges and make recommendations for improving preparedness.