Hospital Response to Radiological Events – Part II

Objective

• Discuss roles of hospital radiation advisors during radiological events

Roles of the Radiation Safety Officer (RSO)

• Preparedness• Training• Command, control,

communication• PPE• Detection• Triage

• Decontamination• Contaminated remains• Logistics• Evidence preservation• Response actions• Exercising “ the plan”

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

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

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

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

Personal Protective Equipment (PPE)

• PPE for decontamination personnel • PPE for healthcare providers• Limitations of PPE• Program management

− OSHA training− Fit testing

• Equipment maintenance

Radiological Self-Protection (For Decontamination Personnel)

• Respiratory - Particulate mask (Level C)

• Enforce time, distance, and shielding

• Dosimeter

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

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

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

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

Radiological Triage

• Triage:− Stabilize the patient first− Ensure ABCs− Prevent internalizing− Consider exposures later

• Segregate contaminated from not

Radiological Triage (Cont.)

Severe medical or life threatening injuries should take precedence over

decontamination!

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

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

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

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

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

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

Handling of Evidence

• Maintaining evidence is critical to investigation

− Clothing− Embedded objects− Decontamination runoff− Bioassay samples

• Chain of custody

EVIDENCE

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?

Radiation Response (cont.)

• Actions when alarms occur− Reduce personal exposure− Limit spread of contamination− Isolate danger areas− Decontaminate

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

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

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

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

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