Medical Emergency Treatment for Exposure to Radiation (METER)

1. Medical Emergency Treatment for Exposure to Radiation (METER) Presented by Roger Hugron Director Nuclear Studies and Analysis 3 Director General Nuclear Safety Department of National Defence

2. Purpose of METER Improve the overall preparedness of the medical community to respond to a RN incident Medical first responders and emergency department (ED) staff Improve their ability to assess and treat individuals who may have: Very high exposures to ionizing radiation Conventional injuries and are contaminated

3. METER - Objectives Radiation Casualty Assessment tool Deliver two-day RN medical emergency response training in five locations Assess the current RN medical response gaps and develop a plan to address them

4. Original Tool • Radiation Casualty Assessment Tool • Developed in 2006 under a CRTI project • Tested during a MEDNEREX at QEII hospital in Halifax

5. Evaluation of Original Tool • Strengths: • Large amount of useful info • Unique guidance for radiological patient care • Weaknesses • Not presented in a format conducive to ED use • Too complex for ED use

6. Evaluation of Original Tool Main recommendations: Reformat and simplify the Tool Highlight unique radiological medical requirements Include lab ordering info and spaces for notes and assessments

7. Improved Tool Designed for use by ED staff Provide background information for decision making Highlight available biodosimetry measures Facilitate recording important clinical information obtained during the history and physical exam

8. Improved Tool Radiation Casualty Assessment Tool Instructions Triage History and Physical Exam Body Mapping Physicians Orders Severity Scoring

9. Instructions

10. Triage Three basic questions

11. History and Physical Exam Vitals Chief complaint Review of systems Contamination or exposure Past medical history Social history

12. Body Mapping Injuries, burns or skin changes Contamination

13. Physicians Orders Labs Specimens Medications

14. Severity Scoring Neurological Hematologic

15. Severity Scoring Cutaneous Gastrointestinal Decorporating agents Onset of vomiting

16. Miscellaneous Physical exam Labs & Investigations Course in ED Biodosimetry Onset of vomiting Lymphocyte depletion rate Severity scoring

17. Course Objectives Educate and train the participants in the proper and safe response to a radiological situation with medical casualties Enhance knowledge of participants to improve their ability to manage and treat casualties from a radiological or nuclear event

18. Original Training One-day RN medical emergency response training in preparation for ExIT-08 Formal lectures and tabletop exercises 12-13 Sep 07 In Vancouver and Victoria For EMS and hospital staff Received positive feedback

19. METER Training Formal lectures and tabletop exercises for EMS and hospital staff Two-day RN medical emergency response training Materials continuously revised and improved Conducted training and tabletop exercises in: Quebec City (10-11 Nov 08) Toronto (1-2 Dec 08) Ottawa (19-20 Jan 09) Halifax (4-5 Feb 09) Vancouver (30-31 Mar 09)

20. List of Lectures Radiation basics Radiological events requiring a medical response Radiation biology and health effects On-scene response On-scene medical management Demo of radiation protection instrumentation Measuring radiation and contamination

21. List of Lectures Intro to Radiation Casualty Assessment Tool Managing the acute radiation syndrome Managing the acute radiation cutaneous syndrome Managing internal contamination Emergency department management Events recovery Federal and provincial resources available

22. Schedule

23. Schedule

24. Capability Assessment Large variability First responders Receive training (FRTP) Plans for on-scene response are well developed ED staff less prepared than first responders No standard training Limited planning Limited equipment Lack of awareness of resources available

25. Recommendations • The METER course needs a federal champion • Certification • Web-based interactive version • Standards should be developed • A database of resources should be created • A Canadian web-site should be developed • Preparedness should be improved through training of personnel and preparation of response kits

26. Positive impacts of training Emergency Health Services in Halifax made a recommendation to change their policy to allow the transportation of casualties contaminated with radioactive material Improved the knowledge and awareness of participants and demonstrated that a comprehensive training program such as deliver by this project is needed across Canada

27. Future of METER The following provinces have expressed interest in additional training sessions: British Columbia - Vancouver Ontario – Toronto, Ottawa, Sudbury, Kingston, Hamilton Quebec Nova Scotia Partners will meet at the end of June to discuss how to ensure the continuity of this training program certification

28. Partners • Pat Kenny - International Safety Research • Dr. Diana Wilkinson - DND/DRDC Ottawa • Dr. Carl Jarvis - QEII hospital (in Halifax) • Dr. Slavica Vlahovich and Cdr Dave Wilcox - DND/DG Health Services • Bob Irvine, Guy Desnoyers, Diego Estan, Peter St-Michael - CNSC • David Duchesne, J.-P. Auclair - Health Canada • Marc Lauzier - PHAC

29. Questions?