Hospital Response to Radiological Events – Part II

1. Hospital Response to Radiological Events – Part II

2. Objective • Discuss roles of hospital radiation advisors during radiological events

3. Preparedness Training Command, control, communication PPE Detection Triage Decontamination Contaminated remains Logistics Evidence preservation Response actions Exercising “ the plan” Roles of the Radiation Safety Officer (RSO)

4. CBRNE Preparedness Planning • Planning similar to other disasters • Unique characteristics of a radiological event • Must be familiar with local incident management system • “All hazards approach” to disaster planning

5. Staff Preparedness • Rotate staff • Reduce fatigue from PPE • Reduce overall exposure • Limit exposure to ALARA • Regulatory limits: Annual 100 mrem vs. 5,000 mrem • Lifesaving limits never used for property • Manage exposure and training records

6. Training • Prepare for HAZMAT contaminated patient • Supplement training to include radiation safety • Train facility-wide, tailored to the needs of hospital staff • Use realistic scenarios • Use equipment in training • Maintain proficiency

7. Command, Control, & Communications • Accurate, timely notifications • Between event scene and hospital • Internal staff • Between hospitals involved • Internal alarm management • Notify response personnel • Record keeping • Media coordination

8. Personal Protective Equipment (PPE) • PPE for decontamination personnel • PPE for healthcare providers • Limitations of PPE • Program management • OSHA training • Fit testing • Equipment maintenance

9. Radiological Self-Protection (For Decontamination Personnel) • Respiratory - Particulate mask (Level C) • Enforce time, distance, and shielding • Dosimeter

10. Radiation Detection • Recognize exposures • In patient: Information about event, ARS symptoms • In self: Detection instruments • Purposes of detection equipment • Alert to hazards • Hazard assessment • PPE decision • Need for decontamination • Decon efficacy

11. Monitoring Personnel • Person from the site: responder or patient • Quick frisk technique with pancake probe • Area monitor alerts to radiation source • Staff monitoring • Bring hands to probe or area monitor • Frisk suspect areas by exception

12. Monitoring Vehicles • Check for surface contamination • Pancake probe, slowly over each suspect area • Vehicle exterior: Doors, tires, wheel wells, hood, wipers (if dry) • Cab: Pedals, steering wheel, floor • Interior: Patient and crew areas • Residues from transport: Protective covers, discarded items, and where patients lay

13. Monitoring Facilities • Check for elevated radiation first (gamma probe) • Check for surface contamination (pancake probe) • Surfaces: Anything touched or having residues • Equipment used: Handles, exposed surfaces • Check residues before overpack • Decon site and runoff • Patient’s clothing, personal effects, etc. • Staff laundry, used PPE

14. Radiological Triage • Triage: • Stabilize the patient first • Ensure ABCs • Prevent internalizing • Consider exposures later • Segregate contaminated from not

15. Radiological Triage (Cont.) Severe medical or life threatening injuries should take precedence over decontamination!

16. Who Needs Decontamination? • Decon of casualties arriving at the hospital • Already decontaminated • Home showered and laundered • Not decontaminated • Decon of healthcare providers • Decon team members • Treating personnel • Transport and support staff

17. Personnel Decontamination • Monitor/wash hot spots • Hands: Soap and water • Hair: Shampoo • Feet: Remove shoes • Clothes: Remove outer layer • How-to • Tepid water, not hot/cold • No scrubbing! • Gently rinse • Monitor and repeat as needed

18. Radioactive Objects On/In Patients • Quick scan to determine radiation hazard • Remove clothing (modestly!) • Account for personal effects • Monitor and control items • Irrigate wounds (if possible) • High radiation objects • Place in tray away from others • Handle with hemostats

19. Decontamination of Facilities/Objects • Protect area from contamination spread • Plastic sheeting on floor, in vehicles • Survey instrument to locate hot spots • Wash/rinse as needed • Control runoff • Send samples to supporting rad lab

20. Contaminated Human Remains • All-hazards exposure risk • Decontamination • Containment • Refrigeration until definitive disposal • Follow legal, medical, cultural protocols • Establish cooperative agreements for fatality management • Secure personal effects • Not all can be decontaminated

21. Logistics • Supply priority: “Get the right stuff to the right place at the right time” • PPE • Detection equipment distribution plan • Decontamination setup • Equipment maintenance program • Calibration • Scheduled checks and services

22. Handling of Evidence • Maintaining evidence is critical to investigation • Clothing • Embedded objects • Decontamination runoff • Bioassay samples • Chain of custody EVIDENCE

23. Radiation Response • Plan for who does what, when • Dosimeters: Who wears them? • Survey meters: Priority of effort • Patients? Equipment? Facility? Vehicles? • Area monitors: Which entrances? Remotes?

24. Radiation Response (cont.) • Actions when alarms occur • Reduce personal exposure • Limit spread of contamination • Isolate danger areas • Decontaminate

25. Example Area Alarm Response • Security acknowledges alarm • Stop offender, divert to safe area • Questions to investigate alarm • Receive any nuclear medical procedure? • Anyone close receive same? • Work with radioactive materials? • Involved in bombing or suspicious incident? • Where were they last?/Why come to hospital? • Follow up as needed

26. Exercise the Plan • Start small, few casualties, simple problems • Be realistic—but only as needed • Safely handle radioactive sources • Coordinate with other agencies/hospitals • Exercise with all hazards approach

27. Tabletop Exercise Guidelines • Define reasonable objectives • Basic scenario to address objectives • Who should/could participate • What level of involvement: Responder? Executive? • What point to start and stop play • Limit actions to discussion (not actually done) • How much is presented to players • Prepared handouts or presentation graphics • Facilitator keep on track and on schedule

28. Example Tabletop Scenarios • Person enters and sets off alarm • Front door vs. ED • Nuisance vs. actual alarm • Ambulance inbound with reported “hot” patient • Vary type and extent of contamination • Radiation survey discovers contamination • During a radiation event vs. routine check • In the ED vs. foyer • In an ambulance

29. Key Points • Plan and train for radiological events using all hazards approach • Use these materials to prepare instruction for hospital staff • Basic or advanced radiation safety • Operate and maintain each instrument • Round-table discussion of risk mitigation