Lessons Learned in Preparing for Receipt of Large Numbers of Contaminated Individuals

1. Lessons Learned in Preparing for Receipt of Large Numbers of Contaminated Individuals Ken Miller Penn State Hershey Medical Center kmiller@psu.edu

9. Alternate Decontamination Sites • Alternate decontamination facilities might include school gymnasiums, fire stations, public meeting houses, indoor arenas, campgrounds, etc. • During a recent drill HMC used an airport hanger for handling of simulated mass casualties. Allowed effective care and treatment of over one hundred individuals per hour.

10. In Field Decontamination Capabilities • The in field mass decontamination capabilities may have to be used with non-ambulatory, contaminated individuals, as well.

11. In Field Mass Decontamination

12. Mass Decontamination

13. Mass Decontamination Water • Runoff • Responders should closely monitor the direction of runoff to prevent cross contamination between lanes and between zones. • EPA and Runoff • The EPA has stated on record that they will not hold responders liable for run-off in a chemical or biological incident caused by a terrorist event. (Letter dated 9/17/00 from the EPA)

14. Systematic Approach • A systematic approach to handling large numbers of potentially contaminated individuals is necessary. • Such an approach should provide for surveying, mass decontamination, resurveying, advanced decontamination (if necessary), resurveying and additional decontamination or ED care as indicated.

15. Contamination Surveys • Survey with GM survey meters • Use nuclear medicine and radiation therapy technologists (familiar with use of instruments) • Goal is <5 times background • Prepare protocol for survey & documentation REAC/TS • Probe held ~ 1/2 inch from surface • Move at a rate of 1 to 2 in. per second • Follow logical pattern • Document readings in counts per minute (cpm)

16. Mass Casualties, Contaminated butUninjured People, and Self Presenters

17. Directions • Clear directions (in appropriate languages) are necessary to help individuals understand what is expected of them.

18. Directions • Clear directions (in appropriate languages) are necessary to help individuals understand what is expected of them.

19. Decontamination Tent

20. Decontamination Tent

22. Decontamination Tent

24. Psychological Casualties • Fear of radiation and misunderstanding of consequences • Long term psychological effects could arise 48-72 hours after an incident • Counsel on acute and potential long term physical and psychological effects • Psychological effects include: Anxiety disorders Post traumatic stress disorder Depression Insomnia Traumatic neurosis Acute stress disorder

25. Psychological Casualties • Terrorist acts involving toxic agents (especially radiation) are perceived as very threatening • Mass casualty incidents caused by nuclear terrorism will create large numbers of worried people who may not be injured or contaminated • Establish a center away from the ED, and if possible, away from the hospital, to provide psychological support to such people. • Set up a center in the hospital to provide psychological support for staff

26. Preplanning • Written Medical Radiation Emergency Plan • Assurance of appropriate supplies and equipment • Training of personnel, including periodic drills • Post drill critiques and refinement of program

27. Preplanning for Mass Casualties • Alternate plans for handling large numbers of contaminated individuals. • Designation of off-site decontamination facility. • Disaster drills.

28. Triage SiteInformation • Develop prepared information packets with Media Relations in advance with message for incidents involving radiation. • CDC website has Emergency Instructions for Individuals and Families titled, “FAQ About a Radiation Emergency” Available in English Español Deutsch Français Tagalog Chinese

29. Triage SiteInformation

30. If Hospital is in Fallout Zone • Initiate environmental monitoring. • Have air handling systems properly controlled. • Prepare briefs for staff. • Advise Administration. • Move inward and downward as indicated. • Prepare for evacuation if ordered.