Reception Centers and Sheltering Community Reception Centers and Volunteer Staffing

1. Reception Centers and ShelteringCommunity Reception Centers and Volunteer Staffing John A. Williamson Administrator Environmental Radiation Programs March 23, 2011

4. What’s Next?

5. Call the Feds?

6. NRF Nuclear Radiological Incident Annex Response Activity Federal Agency Capabilities/Responsibilities Population Monitoring • The Department of Health and Human Services (HHS), through ESF #8 – Public Health and Medical Services and in consultation with the coordinating agency, coordinates Federal support for external monitoring of people. • HHS assists local and State health departments in establishing a registry of potentially exposed individuals, performing dose reconstruction, and conducting long-term monitoring of this population for potential long-term health effects.

7. NRF Nuclear Radiological Incident Annex Response Activity Federal Agency Capabilities/Responsibilities Population Decontamination • Decontamination of possibly affected victims is accomplished locally and is the responsibility of State, tribal, and local governments. • Federal resources are provided at the request of, and in support of, the affected State(s). HHS, through ESF #8 and in consultation with the coordinating agency, coordinates Federal support for population decontamination. • HHS assists and supports State, tribal, and local governments in performing monitoring for internal contamination and administering available pharmaceuticals for internal decontamination, as deemed necessary by State health officials.

8. Population Monitoring and Decontamination • Limited Federal resources for monitoring/decontamination of the public. • Federal resources will take time to arrive.

9. Should the state radiation program do this monitoring? • 70% of the state radiation programs in the US are part of the health department • Do they have the resources? • What about the ones that are not part of health?

10. What am I (State of Florida) expected to do? • Monitor population for radiological contamination • Onsite-Typically done by Fire Rescue Decon Teams • Offsite-Emergency Mgmt, Health, First Receivers • Hospitals (Should be injured personnel only-contamination alone is not considered a medical emergency) • CRC (Stadium, shelters, reception centers, etc.)

11. How many people may require monitoring? • Depends on type of event, type of notification • Goiania, Brazil Cs-137 exposure >100,000 requested monitoring, 237 found contaminated • Tokyo, Japan-Sarin Gas attack in subway >5500 reported to hospitals, ~1000 mild injury, 37 severe and 17 critical.

12. Community Reception Centers Local response strategy for conducting population monitoring • Multi-agency effort, public health lead • Staffed by government officials and organized volunteers • Opened 6-48 hours post event • Located outside of hot zone • Comparable to PODs, NEHCs

13. Community Reception Centers • Services include: • External contamination screening • External decontamination • Limited medical care • Services may include: • Assessment of internal contamination • Assessment of need for bioassay • Collection of bioassay • Main purpose is to prioritize people for further care • Ease burden on hospitals • Manage scarce medical resources

14. Origin CRC Endpoint Home Affected Area Public Shelter Surrounding Community Hospital or Alternate Care Site

15. Evaluate Needs and Resources • Technical - Procedural Guidance/suggestions • Equipment Needs:GM friskers for small numbers GM or Scintillation portal monitors for large numbers (can you effectively screen 100K people with handheld instruments?) Floor covering anti-c clothing changes/personal possession bags computers/bar code software/wristbands • Facilities - Where can/should I set up a CRC? • Personnel - How many surveyors are needed for large event? Admin/medical/logistical support?

16. Technical Resources

17. The Best Place to Start! • CDC’s Virtual Community Reception Center • http://www.orau.gov/rsb/vcrc/ • Provides overview of CRC process • Provides flow charts for CRC • Aids in determining resources required for specific circumstances

18. Community Reception Center Process Flow 7 Stations: Contamination Control Zone • Initial Sorting • First Aid • Contamination Screening • Wash Clean Zone • Registration • Radiation Dose Assessment • Discharge

19. Equipment Resources and Needs • Florida Equipment Resources: (2006) • ~20 portal monitors, primarily in power plant counties. • Hundreds of GM friskers, also primarily in power plant counties. • Emergency Dosimetry

20. Equipment Resources and Needs • Florida Equipment Needs • More Portal Monitors (20+ for statewide distribution) • Friskers • Dosimetry • Equipment for internal screening (friskers, NaI) • How am I going to make up the difference?Homeland Security Grants • 22 portal monitors (Spring 2008) • 200 instrument kits (Spring 2008) • 40 Digital ratemeter/scalers with pancake GM and NaI (in process)

21. GM friskers (Ludlum 2401P) • EC GM high range instrument (Canberra Ultra-radiac) • Electronic dosimeters (Thermo EPD) • 22 Scintillation based mobile portals (20 Johnson AM-801, 2 Canberra Mini-sentry)

22. Facilities • Stadiums, schools, community centers • Facilities used for E shelters, PODs, NEHCs • Need to consider special needs and pets • Showers (decon) available or brought in • Need to direct (not capture) flow of runoff from decon • Coordinate in advance with local health/EM/Red Cross • Controlled clean area for breaks/meals for staff • Securable facility

23. Personnel Resources Most state radiation programs have limited personnel resources • FL DOH Radiation Control has 80 technical personnel (FL is a large program!) deployed to: • SEOC 6 personnel • County EOC 6 personnel • Mobile Lab 21 personnel • Field Teams 23 personnel • Incident Command Facility 24 personnel • Available for population monitoring -0- personnel

24. FDOH Assets • Environmental Health Strike Teams • “Army of 160” • At least one team per region (seven regions, eight teams). • Already trained for other types of emergency response situations. • There is already a generic “typing” for teams. • Rad training added as a credential for the team. • BRC “Advanced” response course - 16 hour training • All teams trained (~90 personnel), and supplied with radiation kit, refresher training continues.

25. FDOH Assets • FDOH county env. health staff • Hundreds of environmental specialists. • All trained in ICS, NIMS, hazmat awareness. • Many have extensive experience in emergency response for hurricanes. • Training • “Advanced” response course 8-16 hours training • Fundamentals course – 4 hour training

26. Concerns • Many other responsibilities of strike teams and CHD staff mean training/exercise time not likely to increase. • Limited radiation training to enable critical decision making about contamination issues. • Very little professional experience in DOH or state government in general with radioactive contamination. • Importance of having knowledgeable personnel to reassure public at reception centers is critical.

27. Volunteers? • Post Hurricane Andrew ‘92 - Florida requires volunteers to register – unregistered (spontaneous) volunteers will not be used in emergencies • Registration allows the state to assure that volunteers are qualified • Registration allows the state to assure that only those needed will be called • Registered volunteers are covered by state liability insurance and Good Samaritan laws • But what type of volunteers should we be recruiting? And how? • Training needs?

28. Volunteers! • >22K certified radiographers, xray techs, medical health physicists, nuclear med techs, radiation therapists form a large potential pool of volunteers • Many other industrial, governmental and academic HP’s and RSO’s • Already trained in basic rad safety • Many with experience in personnel decon • Use Medical Reserve Corps to set up a subset: Radiation Response Volunteer Corps • Outreach to FL Chapters of HPS, AAPM, FL NMT Society, FL Society of Rad Techs • Start Registering Volunteers!

29. RRVC Training • Use local MRC regions to set up training (CDC-CRCPD grant funded) • Use Training staff of BRC to develop curriculum (4 hour didactic/3 hr hands on) • Hands on uses equipment • Use Training staff and Professional staff to present training to MRCs • To Date: 320+ personnel trained • Saturday March 19, Internal Dose Measurement course delivered

31. Additional CRC Staffing needs • Greeters • Special Needs • Medical • Registration • EPI • Counseling • Security

32. Summary - Building a Population Monitoring Program • Technical - Develop SOPs for population monitoring CHD POD modelCDC vCRC for setup of flow, equipment, personnel needs • Equipment ResourcesDOH Radiation Control provides rad equipment and proceduresLocal health provides tracking software, computers • TrainingDOH Radiation Control provides training for MRC/RRVC • Facilities/other equipmentCHD/EM provides locations, logistics, supplies • PersonnelMRC RRVC, local health, EPI strike teams, DMAT, env health strike teams, CERT

33. Questions? John Williamson Administrator, Environmental Radiation Programs Bureau of Radiation Control Florida Department of Health 407-297-2096 John_Williamson@doh.state.fl.us http://www.doh.state.fl.us/Environment/radiation/index.html