ML092520252

Submittal of Medical Services (MS-1) Drill Report

ML092520252
Person / Time
Site:	Dresden
Issue date:	09/02/2009
From:	Odeshoo J US Dept of Homeland Security, Federal Emergency Management Agency
To:	Document Control Desk, Office of Nuclear Reactor Regulation
References
2009-07-14
Download: ML092520252 (25)

Text

U.S. Department of Homeland Security Region V 536 South Clark Street, Floor 6 Chicago, IL 60605

~FEMA (ND S~

SEP 02 2009 NRC HQ Document Control Desk U. S. Nuclear Regulatory Commission Washington, DC 20555-0001 To Whom It May Concern:

Enclosed is one copy of the Dresden Nuclear Power Station Medical Services (MS-1) Drill Report. The drill was conducted in Pontiac, Illinois, on July 14, 2009. Participants included members from the Illinois Emergency Management Agency, Duffy Ambulance Service, andthe Order of Saint Francis - Saint James, John W. Albrecht Medical Center.

No Deficiencies and no Areas Requiring Corrective Action were identified during this drill.

If you have any questions, please contact me at (312) 408-5575 or William E. King at (312) 408-5575.

Sincerely, S

Mdeshoo Acting Regional Administrator Enclosure www.fema.gov

Dresden Nuclear Power Station Drill Report - 2009-07-14 Final Report - Radiological Emergency Preparedness (REP) Program 2009-08-28 hFEMA

!FE:M )

Drill Report Dresden Nuclear Power Station-Drill Date:

Report Date:

2009-07-14 2009-08-28 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency REP Program 536 S. Clark St. 6th floor Chicago, IL 60605.

I Table of Contents Chapter 1. Executive Summary Chapter 2. Drill Evaluation and Results Section 2.1 Medical Services (MS-i) Transportation - Duffy Ambulance Service Section 2.2 Medical Services (MS-I) Hospital - OSF Saint James Hospital Appendices Appendix 1 - Drill Evaluators and Team Leaders Appendix 2 - Drill Evaluation Areas and Extent of Play Agreement

1. Executive Summary On July 14, 2009, the U.S. Department of Homeland Security's (DHS) Federal Emergency Management Agency (FEMA), Region V, evaluated a Medical Services (MS-I) drill in the 10-mile plume exposure pathway Emergency Planning Zone (EPZ) around the Dresden Nuclear Power Station (DNPS). The purpose of the MS-1 drill was to assess the ability of off-site agencies to respond to a medical emergency involving a potentially radiologically contaminated member of the public. The MS-1 drill was held in accordance with DHS/FEMA's policies and guidance concerning the exercise of State and local radiological emergency response plans.

DHS/FEMA wishes to acknowledge the efforts of the personnel from the State of Illinois Emergency Management Agency (IEMA), Duffy Ambulance Service, and the Order of Saint Francis - Saint James, John W. Albrecht Medical Center who participated in the MS-1 drill.

The scenario for the MS-1 drill-was developed by personnel from the State of Illinois.

The drill scenario stated that a General Emergency was declared at the Dresden Nuclear Power Station. The emergency alert sirens have sounded, the public has been directed to evacuate affected areas and to report to Reception Centers set up in the local area. The scenario is based on a local resident who had just returned from traveling and is unloading her luggage from her vehicle. The resident has not heard the evacuation order over the local radio station or the order to report to the Reception Center. While unpacking she hears that a radioactive release has occurred from the Dresden Nuclear Station and that members of the public living in her area are to report to the Reception Center located in Pontiac, Illinois. Radiation monitoring and, if necessary, decontamination, of evacuees is provided for at these facilities by staff from IEMA under the Illinois Plant for Radiological Accidents (IPRA). The resident grabs a few necessities and leaves her home,.however when leaving she slips and-falls down her front porch stairs sustaining an internal injury to her right arm.

While driving to the Reception Center the resident's arm begins to hurt and is difficult to move. Upon arrival at the Reception Center the pain becomes more intense and the resident's arm has become very stiff. As IEMA staff processes her through the radiation monitors they discover that she is contaminated and cannot straighten her arm. As the resident is being surveyed she has intense pain in the right arm in which she caught herself. She explained the fall incident and her discomfort to the IEMA staff and they immediately called Duffy Ambulance to transport the resident to Order of Saint Francis -

Saint James, John W. Albrecht Medical Center. An ambulance was dispatched to the Reception Center. The IEMA staff advised the Duffy Ambulance Service to transport the person as a contaminated injured patient.

The Reception Center was simulated for this drill and was actually located at a garage area on the OSF St James Medical Center property. The Duffy Ambulance Service's vehicle was pre-positioned near the simulated Reception Center.

1

The resident was kept comfortable while the ambulance was in route. Decontamination at the Reception Center was waived due to the individual's injury. There was simulated bruising and slight swelling of the right arm. There were no-visible lacerations or bone dislocation., The resident was simulated as being allergicto Septra and Tramadol and.

having a history of anxiety andasthma..

Due to the condition of the-patient, decontamination was not attempted andvwas pending:the patient's safe'arrival atthe medical center.

The preliminary monitoring survey performed by the IEMA personnel identified general contamination on right and left palm, forehead, right pant knee, left pant knee, both pant cuffs and bottom and toes of shoes.

The Duffy ambulance service arrived at the Reception Center with two EMTs (ambulance driver and assistant) that assessed the individual's injury. The IEMA Medical Radiological Technician (MRT) at the Reception Center advised the EMTs of the patient contamination levels and complaint of injury to the right arm. The EMTs communicated the situation and patient status, to include vital signs, to the medical center. The IEMA MRT joined the EMTs in the ambulance and rode to the medical center with the patient.

While the individual was in transit, the staff at OSF St James Medical Center having been notified of the pending arrival of a radiological contaminated patient declared a Code Orange. This action commenced preparations for receiving and the treatment of a contaminated patient. The necessary staff responded to the Emergency Department (ED). The Emergency Department's vehicle entrance area was cordoned off using yellow tape and traffic cones. The ED Decontamination room was prepared and the responding staff donned Personal Protective Equipment, as necessary. A second IEMA MRT was pre-positioned at the ED to assist the medical staff in the monitoring and decontamination`&offthel patient.*--.

Upon arrival at the OSF St James Medical Center a successful transfer of the individual from the Ambulance gurney to a patient transfer bed was conducted by the EMTs and hospital staff. The EMTs and the ambulance were properly surveyed by the IEMA MRT from the Reception Center. The ambulance and EMTs were then released to return to normal service.

The patient was then moved into the Decontamination Room. The hospital staff attended to the patient giving priority to the injury, while maintaining awareness of the radiological contamination. Together the IEMA MRT and hospital staff successfully treated-the patient's injury and conducted decontamination procedures. Afterwards effectively decontaminating the patient and removing her from the Decontamination Room. The patient was moved to a treatment room within the ED for further observation by the attending physician. The IEMA MRT properly surveyed the attending hospital staff and processed them out of the Decontamination Room. The IEMA MRT also addressed the proper survey, disposal and handling of contaminated materials and the 2

decontamination and clean-up of the Decontamination Room.

During the MS-1 drill, Criterion 6.d Transportation and. Treatment of Contaminated Injured Individuals, which is part of the-sixExercisejEvaluation Areas described in Federal Register notice [67 FR 20580-20602]; Ap~il 2002, which amends the FEMA-REP 14, Radiological Emergency Preparedness Exercise Manual, was evaluated. The State and local organizations demonstrated knowledge of their organizational.-

emergency response plans and procedures' and adequately implemented them. No-issues were identified as a result of this drill.

j

.3

I Table 1. - Summary of Drill Evaluation DATE: 2009-07-14 SITE: Dresden Nuiclear, Power Station, IL A: ARCA, D: Deficiency, M: Met, N: Not Demonstrated

-Mobilization l.....

1al Facilities IbI Directibn andConto61

.cl Communications Equipment

Idl, M

M Equip & Supplies to support operations lel.

.M M

Emergency Worker Exposure Control 2al Radiological Assessmefit and PARs

- 2b1.

Decisions for the-Plume Phase -PADs

,.2b2, PADs for protection of special populations

'2c] l Rad Assessment and Decision'mking for the Ingestion Expouie Pafthwray 2di Rad Assessment axidDecisihn*miiking acdnzerning Relocatio'., Reenýiry, aiid Returnm'.

2e1'

~Pi-otýctive AcionImhlucit~eeiatiow>j Implementation of emergency worker exxposure control' 3al M

Implementation of KI decision 3bl Implementation of protective actions for special populations - EOCs 3cl Impleijientatid. of protectiVe actibns fdi.Schools 3c2 Implementatibn~oftraffic-and access contrbl p..

T3d1 lmrpedimeits.to:evacuation are~ideniified and resolved.

3d2.

lementation of ingesti6n jathwayýdecisions - avaaiab*i/ue of ijifo

'3el' Materials' for Ingestion Pathway PADs are'available 3e2 lImplementatioii 0:rel ocition,ire eitry; and retorn decisio,

• -3'1

-3 Field Nleasiireinent aiic,,alSrii Adequate Equipment for Plume Phase Field Measurement-4a]

Field Teams obtain sufficient information-42 Field Teams Manage Sample Collcciion Appropriately.'-"

4a3 Post plume phase field measurements and sampling 4bl Laboratory operations 4c1 Activation of the prompt alert and riotification system 50__

Activatioti of the prompt aleit and notification systfm. 2 FastýBreaker"

.5a2 Activation-of the prompt alert and notificationsystem - Ex'ception areas 5a3 Emergen.cyinformation and instructions for the public and thermedia 5b]

• Supj*ori*Opar"atioisf'aiiitie*

  2 ! '

i**::

i Mon / decon of'emrrgency 'worker 6quipment 6bl Temporary care of evacuees 6c1 Transportation and treatment of contaminated injured individuals 6d1 M

M I

I I

I I

I I

I I

Il I

I I

I I

I I

.4

2. Drill Evaluation and Results.

2.1. Medical Services (MS-I) Transportation,- Duffy Ambulance Service On Tuesday, July 14, 2009, a Medical Services (MS-I) Drill was conducted at the OSF St James Medical Center, 2500 West Reynolds Street, Pontiac, Illinois. In accordance with the extent of play agreement, the ambulance and crew from the Duffy Ambulance Service and an Illinois Emergency Management Agency (IEMA) Radiological Monitor (RM), assigned to provide services at the simulated Reception Center and in the ambulance, participated in the MS-1 Transportation drill.

Transportation of a contaminated injured patient to OSF St. James Medical Center-was

'demonstrated as an out of sequence activity at 0900 hour0.0104 days <br />0.25 hours <br />0.00149 weeks <br />3.4245e-4 months <br />son July 14, 2009 by Duffy Ambulance Service. The exercise began at.0925 hours0.0107 days <br />0.257 hours <br />0.00153 weeks <br />3.519625e-4 months <br />, when an.exe'rcise controller made a.call to.Duffy Ambulance Service requesting an ambulance to report to the public Reception Center-and advising them that-an individual had injured her right arm in afall.

..The Medical Radiological Technician (MRT) for the Illinois Emergency Management Agency (IEAM).,.Division of Nuclear Safety (DNS).wore dosimetrynconsisting of one DCA Model 622 DRD with a range of.0-20;R,forrthe radiological incident and a Landauer Inri;Lght Systems Lumineýceii'eDosim eter (LD) as'aa mea nshof recording' permanent radiation exposures. The MRT was wearing a one-piece Tyvek suit, rubber gloves, booties and a surgical mask.

At 0930;h-ours the Medical Radological Technician (MRT).f0o the Illinois Emergency.

Management Agency (IEMA), Division of.Nuclear Safety.(DNS) began-surveying the injured individual.- Surveying was-completbd-at-,0938-hours.' The foilowing simulated radioactive contamination levels were found:,3,600 counts per minute (cpm) on left pam, -1,500 cPm on left knree,-3,000 o

p.n.-.i

-- n

_ft _slhoe,-2, 0j-0 Cprm onrleft pait cuff, 1,500 cpm on right knee, 3,000 cpm on right shoe bottom and right pants cuff, 1,200 cpm on left forearm,-"3,000 cpm on-right-palm and--1,600.cpm at the front-of the hair'line on the head. Booties were then placed on the feetof the, victim to prevent'spreading contamination.

The ambulance andtwo Emergency Medical Technicians, (EMITs) paramedics arrived -

on scene at 0940 hours0.0109 days <br />0.261 hours <br />0.00155 weeks <br />3.5767e-4 months <br />. One of the EMVTs was also the driver. The EMTs got out of the ambulance wearing yellow Poly CoatV DuPont suits with hoods, yellow shoe covers, surgical masks, -safety glasses and two pairs'of surgical gloves. -The patient Was alert, and responsive when the ambulance arrived but complained of a sore right arm.,

The EMTs first tended to the patient by applying-a neck collar and a'cloth'-type sling under the right arm to keep it immobilized. The MRT then monitored the EMTs' hands for contamination, and the outer surgical gloves were changed out. The MRT the briefed the EMTs of the levels and locations of radioactive contamination found. The EMTs then obtained a backboard and placed three blankets on it to use for cocooning of the patient.

5

The *patient'was then placed on the backboard, cocooned and strapped down, and then lifted onto abn ambulance gurney.. The EMTs then had their hands monitored for radioactive contamination and replaced their outer surgical gloves.

The gurney~was then loaded into the-ambulance with one EMT attending to-the patient while the other EMT drove. ýThe-MRT'also escorted the patient and ambulance-:crew in the ambulance.

After the patient Was loaded into the ambulance, the EMT with:-the patient-monitored for vitals. The following vitals were noted:. level of-consciousness - alert and oriented, respirations.- 40,ý pulse'- 1.45, skin-- normal, pupils-- PERL, blood pressure (BP) 140/1:00, and visual "-slight swelling and bruising-of right arm. -At 1008 hours0.0117 days <br />0.28 hours <br />0.00167 weeks <br />3.83544e-4 months <br />, the EMT escorting the patient contacted the hospital to via MERCI to inform the hospital all further communications with the hospital would be via the Med Line not MERCI so the MERCI channels could 'be used for actual emergencies., At 1012 hours0.0117 days <br />0.281 hours <br />0.00167 weeks <br />3.85066e-4 months <br />, the EMT.

escorting the patient notified the hospital via the Med Line that the ambulance was en route and informed the hospital of the:patient's.,initial vitals.

The' patient's vital were monitored again.while en route to the hospital. The following simulated, vitals were noted,: levelof consciousness-alert and oriented-, respirations -

38, pulse - 135, skin:- normal, pupils" - PERL BP,.130/100 and.visual.'-!slight, swelling and bruising of the-arm. The EMT, escorting the patient then notified the' hospital-of the vitals via the Med Line.

The ambulance arrived at:the hospital at.101:8 hours. The.area outside of the Emergency, Room (ER) entrance designatedfor the arriving ambulance was m.arked off with plastic traffic, cones and yellow,.cautiofr -tape.. -After the ambulacce arrived, it was met by hospital staff.and the patient was: trarinsferred from.the gurney to a patient transfer bedýto betaken into the REA.,,

After the patient transfer was completed, the MRT surveyed the EMT driver for contamination, and protective clothingdýoffing procedures were demonstrated-.. The MRT then surveyed the EMT escorting the patient; and the EMT was allowed to doff her-.

protective clothing. Then the MRT monitored the ambulance for contamination. The following areas were monitored: gurney wheels,.patient pad, cabinets used.by the EMT, patient area bench. pad, floor, cab floorboard, steering wheel, driver's seat, inside, door, handles,, radios, running boards and rear.bumper.and step.

The MRT explained the area around the'ambulance would also be.monitored for any contamination;. and that if contamination:wasfound on the ambulance, it-would be sent.

to t!e designated vehicle monitoring and de.contamination station.

The ambulance-was released at 1049-hours.

The Duffy Ambulance Service ambulance, dispatched for this drill was: equipped with two 6

I I

I I

I.

I

-I I

I I

-I I

I I

I I

I

multi-channel, two-way radios for communicating through the Medical Emergency Radio Communications of Illinois (MERCI) System. The system operates on an 800MHz frequency, and one radio was located inside the6 patient compartment.and the other radio was located in the.cab of the ambulance. Thisis the normal primary formof communications used by Duffy Ambulance Service. The radio in the patient compartment was monitored on a regular basis during transport of the patient., The.-..

radio-was utilized to notify the dispatcher of the ambulance participating in a drill.

The driver, an EMT, and assisting EMT, were each equipped with cellular telephones and 9-1-1 pagers. The EMT in the patient-compartment utilized a cellular telephone to' establish and maintain.contact with the hospital during the drill in order.to keep the.-

MERCI channels open for actual emergency communications and not risk having dispatchers and other radio users believe an actual. radiological emergency was 'taking place.

No failures of the communications systems were noted during, the drill..-.

The radiological emergency response survey meter kit maintained by theIllinois.,

Emergency Management Agency (IEMA) Division of Nuclear Safety (DNS) contained one Bicron Micro-Rem Ion Chamber survey. meter with an internal,-;tissue-equiValent,l organic scintillator, with four scales giving a range-of dose measurement of gamma.or X-radiatidn of 0 to 200,000 microrems (p rei'n)- or-0.2"rem with no-R/hr conversion required. The Bicron Micro-Rem meter-was lastcalibrated on August 19,.2008.,-!

The second survey meter was a Ludlum Model 2241-3 with three different detectors available: a Ludlurn Model 44-9, GM-pancakd-type.halogen quenched for detecting alpha, beta'and gamma radiation;-a-:Liudlum :Model,44-10, low-level, wide energy,,:%

gamma sodium iodide scintillator;<!and a Ludlum Model[43-65 alpha detector. The Model 2241-3 has four display options.0*0' pR/h,r-to 9,999 R/hr;.0.000':pSieverts (Sv)/hr to 9,999 Sv/hr; 0-to-999k cpm;-or'0 to 100k-cps. This'survey meter was lastcalibrated.

on August 20, 2008.

Both survey meters were-operationally'tested' before-the drill, and both survey meters.

are due for annual calibration in August2009:;'.

The radiological emergency response bag, for. carrying other than radiation -survey instruments, as displayed by the IEMA Medical Radiological Technician.(MRT), was sufficiently stocked with Tyvek suits, surgical masks, booties, cotton inserts, surgical.-

gloves, tape, safety glasses, replacement batteries, dosimetry kits, and one CD V-750 Model 6, pistol-grip direct-reading dosimeter (DRD)'charger: The dosimetry kit" demonstrated contained on -DCA Model 622 DRD with a range of 0 - 20R, and was last tested on May 4, 2009, one Landauer In-Light Systems Luminescence 'Dosimeter (LD)t with a change out date of June 2010, 14 130mg iOSAT KI tablets in a blister pack with a listed expiration date of June 2007, one Emergency Worker KI PotencyCard dated-May 2007 explaining the KI would remain sufficiently potent, one Thyro-Block KI Instruction Sheet, and one blue Radiation Exposure Record/Kl IngestionCard with dosimetry use' 7

I I

instruction on the back.

During a discussion with the IEMAMRT it was.identified that a letterwas on file.,

extending the'date of the shelf.life of-the KI but that he didn't have one with him. A copy of the letter was. later provided: by the IEMA office.

All activities described in the demonstration criterionwere carried out in accordance with the plan, procedures and the extent of play agreement.

Medical Services (MS-I) Transportation.-DuffyfAmbulance Service

a. MET: 1.d.1, 1.e.1, 6.d.1.

b. AREAS REQUIRING CORRECTIVE ACTION: None I

c DEFICIENCY: None

d. NOT DEMONSTRATED: None,

e. PRIOR. ISSUES - RESOLVED:? None I

f; PRIOR ISSUES - UNRESOLVED: None I

rii 8I IB I

2*!,

I I

I

2.2. Medical Services (MS-1) Hospital - OSF Saint James& Hospital The State of Illinois' Medical Services (MS-l) Hospital Drill was performed out of'..

sequence on July,14, 2009, Commencing-at 0900 hours0.0104 days <br />0.25 hours <br />0.00149 weeks <br />3.4245e-4 months <br />, at the Order of Saint Francis Saint James, John W. Albrecht Medical Center, 2500 West'Reynolds Street, -Pontiac, Illinois, where the appropriate space, adequate resources and trained personnel to provide -transport, monitoring, decontamination,'and medical services to contaminated injured individuals was demonstrated. At 1000 hours0.0116 days <br />0.278 hours <br />0.00165 weeks <br />3.805e-4 months <br />, ah announcement was made over a public address system in the Medical Center for a Code Orange. This code signified that a patient contaminated with radiologi.cal materials was' in route to the Emergency Department (ED) at the Medical Center.

Since this was an exercise, the Medical Center was notified of the situation by artificial means; a Controller inject. The IEMA Controller related to the Medical Center, staff via an inject that it had been notified of an event.at the Braidwood-Station, by the Illinois Emergency Management Agency (IEMA) or::hospital representative.stationed at the local Emergency Operation Center.

The nurse's station within the ED contained sufficient radio and telephonic equipment to allow-for the center to communicate with responding ambulance services. The radio system utilized Medical emergency Radio Communications of Illinois (MERCI) 800 MHz channel. During the drill the ambulance and the medical center utilized the MERCI for initial contact. They then switched to their cell phone for the remainder of the drill to allow for the efficient use of the MERCI channel for real world activities. Within the medical center, the public address system was also utilized to inform or provide messages to staff and occupants of the medical center. The telephone system could also be used to communicate internally with the medical center-staff and externally to other outside agencies.

The Medical Centeri-pe(Snhel followed their proceddires and established a secure Decontamination (Decon) Room for receipt of a contaminated injured patient. A public address system announcement was made for a Code Orange and that it was an ED drill. Medical Center personnel either notified or responding for drill activities included personnel from Security, Radiology, the Radiation Safety Officer, Hospital Administrator, Emergency Medical Services (EMS) Emergency Response Coordinator, and ED (Charge Nurse, Services Coordinator, physician, buffer zone monitor, and ancillary personnel.) The hospital radiological Decon Team was not available; attending to real world patients. Other Medical Center persons observed the drill. Through interview with the IEMA representative, it is noted that all persons assisting, along with other Medical Center and ambulance personnel had received Emergency Medical Services for Radiation Accidents training presented by IEMA on the week prior to the drill.

Medical Center personnel readied the Decon Room for patient arrival. The driveway to the Decon Room and the Decon Room itself provided an area that could be controlled with minimal need for security personnel and traffic barriers. During the exercise, yellow Caution tape was strung across the driveway as a visual barrier to control/limit vehicle 9

I traffic. -During the drill, when the'ambulance arrived to off load the contaminated' patient, yellow Caution tape also-was strung in back of the ambulance to cordon off the

'-vehicle from the rear untilit was surveyed before, ý-elease. The ambulance'.off loading.

I area was protected from the weather by a fixed-overhead canopy.

Two-entrances into the Medical Center from the driveway were -available. The. main entrance into the Medical Center wasthrough double electronically controlled doors.,"

Inside the doors to the right was a.f;hort corridor with roll carts containing!equipmient..

The Decon Room was located at the end of the corridor. The Decon Room had its own I

door leading to the driveway. The electronic doorway was not used for this drill.

Also inside the double electronically controlled doors, moving straight ahead, Was I

another set of electronically controlled doors that.opened -up into the main ED. -Duringi the drill, entrance into the main part of the hospital was controlled to preventing non-essential~onot approved persons-from entering potentially contaminated areas. 'The..

secure, corridor-leading to the. DeconwRoom.was, used as a buffer zone' At 1000. hours, an IEMA Radiological Monitor (RM) dispatched (simulated) by his-.:.--

supervisor at the Pontiac Reception Center arrived at-the Medical Center to.. provide.

survey and technical :support to Medical, Center-personnel. The RM surveyed.the Decon Room used forpatient treatment and established a radiological baseline-,He arrived with a metal carrying case containing!survey meters, personnel-dosimetryý,and. other support supplies such as disposable. gloves. Copies of theDecontaminatio.n -Center.,,,-

Monitoring/Action, Log, Form [IEMA 267 (8/05)] were available, -A.copy of this form was 3

used, during the drill by the amb*,ulance IEEMA RM to record patient survey information,.- A copy.filled out with,-patient information-.was1turned over-to the, Medical-Center-tIEMA RM

.during patient transfer.

I Personal dbsimetry included the Afollowing:.a-Dosimeter Corporation of,America Model.,

622-Direct-Reading Dosimeter with a range-of.0-20 R, leak tested on April15, 2009; a,-

permanent reading Landauer Lumninescef,.ýD.osimeter with an effective date of July 08-June10; a Radiation -Exposure, Recordý cardc with-space to record user. information;: an-instruction sheet describing use and precautions for ingesting-potassium iodide.(KI);,

and a pencil gripCD V-750 Model 6 charger-..Also included inthe case were ý14 dose.s of KI provided by iOSAT in 130 mgitablets individually sealed with, an expiration date of June'2007.,A printed card inside-the kit advised the user-that the KI'was tested and the drug was found to be. viable so the expiration date was extended.. The evaluators were informed that a copy of the extension,letter, which identifies the extension date as June 2008, is kept in the command vehicle located at the Reception Center from which the IEMA RM would be dispatched. A copy ofthe letter.was obtained at.the conclusion of the drill The :IEMA RM was-familiar with how to complete the Radiation Exposure Record card' I

with name, social security. number, and.-current date; knew how to wear the, permanent ILandauer-Luminescent Dosimeter, check the-DRD every 15-30 minutes and record.

readingszonthe record.cards.: Hewas aware of the administrative reporting limit (3 R) 10 II

and turn-back value (10 R). By monitoring his own DRDs and -using radiation survey equipment, theIEMAiRM at the Medical Center was aware of local,conditions and Could advise Medical Center personnel of changes in. readings, if-any: Only a very low level of exposure was expected at this facility.. In addition,.a permanent dosimeter supplied by the Medical Center's Nuclear Medicine Department was taped on a wall in the Decon Room-and used for area exposure. It'was reported that the dosimeter is exchanged following the Medical Center's DecontaminatiomGuidelines. After this assignment, the.

IEMA RM' could be. reassigned to another location. Equipment would be checked out at the end of:the mission.:

According to the extent-of-play agreement negotiated with the Department of Homeland Security Federal Emergency Management Office,.-Region V, personal dosimetry was not issued to Medical Center.staff by IEMA.

A Bicron Micro-R. meter, last calibrated on May. 12,2009 and: due for calibration on May 12, 2010; and a Ludlum 2241 digital scalar/rate meter with pancake probes last calibrated on May 12, 2009, with the next calibration due on May 12, 2010, were available. The !EMA RM conducted a systemcheCkof the Bicron survey equipment. In reality, this; process Would have occurred at the Pontiac Reception Center.. The survey meter was checked to ensure that it contained fresh.batteries. The survey meter was.

turned on and allowed to warm up. Instrumehts. passed an operational battery-test~and a source-response check prior~to use by the-IEMA RM..Sources,were: imbedded in the sides-ofthe carrying cases used to transport the; equipment. Operability..check exposure rate and~count rate were recorded'on labels affixed on a side of the instrument. (Bicron Micro-R meter was 11- -'..8m-R/hrý and, the Ludlum 2241n31was 21.6-36.0 kcprn):"iAdditional probesthat were highly sensitive.were-available',to measure..

small areas for contamination.

Using'a Bicron Micro-R meter, a backgro, nd c(;heck was :donebin the Decon, Room shortly Affer the IEMA RM arrived at the.:hos*ita1.- Areading-of 60 counts pdr;minute, was noted, This level was established as~background to be used for future. patient and.

emergency worker care. Decontamination levels-established by.the'State oflllinois are two times background,. In addition totaking background readings, the IEMA RM also spoke with the Decon. Room nurses. He provided guidance on how he would perform surveys on the patient, why they would need to--frequently-change,.their gloves-,

decontaminations methods that could be-used, thathe was there to monitor radiation levels for their. safety also, and that they were the persons responsible forthe medical.

treatment of the patient, which took-priority over-his survey responsibilities.

All supplies needed.to set up the Decon Room and perforrm decontamination activities were stored on carts in the Decon Room and adjacent corridor.- During set up, the carts were wheeled into the foyer and opened. Yellow Caution tape and signs were obtained from one of the carts~and used to visually establish control lines. Receptacles were available, placed in strategic locations, and marked for'contaminated waste items.

Decontamination kits with cleaning supplies, wipes, and protective'clothing-were placed on a supply cart'in the receiving area..When set up was complete; personnel began-11

I I

donning protective clothing..

In preparation to-treat a contaminated.patient, Medical Center ED personnel assisted -I each other as they each donned. Personnel Protective Equipment (PPE) to include a gown; two pairs of gloves, mask, booties, and hair cover that were available on a.cart.

AdditionalPPE supplies were available from the.Medical Supply Center. Other I

available equipment included the necessary supplies for patient decontamination: soap, moist wipes, sterile water, brushes, wraps in various sizes, -and plastic bags to hold_..

contaminated items. Individual packets with protective clothing were available for I

emergency response personnel.

As the Decon Room Was readied-for patient arrival, a Hill Rom (Hillenbrand Industry) gurney Was moved' into the Decon Room and covered with a sheet. A step. off pad.

(chuck) was taped-to th'e floorlin.the bufferzone just outside the doorway of the Decon

• Room and 'another was tape on the, floor just outside of the door leading to the "

driveway-.-

During the drill, the buffer zone moritor~stood on the outside of the Decon Room-.interior doorway to control movement, of, persons':and supplies into and out of the.room.. strip of yellow Caution tape was secured across the doorway to assist in identifying the buffer zone from the hot zone. The monitor recorded medical and radiationsurvey information gathered during patient treatment. +:He also maintained a list of;Medical Center personnel-who came, in contact with the-patient., AllI. information was recorded on,..

Medical Center for~ms (Radiological Accident Monitoring, and Decontamination Form and Emergancy_,Physician Record).,

I A communications center was located inside the main Medical Center ED. The center contained various 2-wayradio ýunits 9nd.tcephones: T-he -radios provide coordinated communication link!s-between the Medcal-CQenter staff and personnel staffing.area fire:.

and ambulance.field based units. Person nel..-from.the ED used, one.,of the 2zway radios,-.

to listen to and speak with an Emergency:Mecai sa !.Technician (EMTs) from the Duffy, AmbulanceService who-participated: inthis drill-.

Slightly after 1110 hours0.0128 days <br />0.308 hours <br />0.00184 weeks <br />4.22355e-4 months <br />, the Medical Center ED staff received a call from the Duffy' Ambulance Emergency. Medical-Servicesteam, over a 2-way radio, that-they were in.:,,

.route to the Medical Center.with a-contaminated patient.. The following patient information was given:-exposed to-radiation,,on the left hand, left shoulder, right foot, -

and right cheek;,injuryto the right arm;,alert and oriented; shortness of breath with asthm.,a and anxiety; respirations.23;'pulse 110*;-blood pressure 125/70; allergic to

-T~ylenol, Motrin,.and Codeine; and estimateditime of arrival.three-four minutes. After receiving the call and logging this information, the Medical Center ED nurse briefed the Decon"Room medical team on the medical and.radiological-conditions of the-incoming patient.

At 1216 hours0.0141 days <br />0.338 hours <br />0.00201 weeks <br />4.62688e-4 months <br />, the ambulance. arrived atthe Medical Center. The ambulancepulled up to the electronic double doors and the patient was unloaded from the ambulance.

12

Patient transfer occurred inside the established vehicle corridor then moved into the-Decon Room. The patient was mummy wrapped in a sheet to prevent the spread of contamination. A clean Medical Center gurney, draped in double sheets, was placed next to the ambulance gurney and the patient was transferred. Care was taken by, Medical Center and ambulance personnel during patient transfer so.as not to spread contamination. Once transferred, a quick assessm-ent of the patient's medical condition was conducted to determine if the injuries were life threatening. The patient's injuries were not considered life threatening..

Concurrent with the medical assessment, the ambulance IEMARM,. assisting with the-patient at the simulated Reception Center and in the ambulance, provided verbal and written format [form: IEMA 267 (8/05)] information to the IEMA RM at the:Medical Center. The' patient'srsurvey information indicated that contamination occurred as follows: left forehead at hairline 1600 cpm, !eft~palm 3000 cpm; left pant knee 1500 cpm, left pant cuff 2000 cpm, left shoe 3000 cpm, right shoe 3000 cpm, right pant cuff 2000 cpm, right pant leg at knee 1500 cpm, right palm 3000 cpm and right forearm-1200 cpm. The patient's shoes had booties placed over them to control the spread of contamination. The Medical Center staff received a'briefing from the, EMTs. The.

briefing covered the information relayed. on thelincoming call, and-reiterated that the patient was contaminated...

.The patient was rolled into the Decon.Room with the medical-team accompanying the patient. The'.buffer zone monitor staffed a station~just outside. of the Decon Room inthe clean 'entryway. After. the patient was, moved into, the, Decon Room, the corridor was-,

monitored to ensure that the area was clean for receiving'additional.patients,.if needed, or clean for persons exiting the Decon Room.

Upon entering the' Decon Room, a throughlphysical assessment of the patient's'injuries

-and' medical, condition were, conducted:-. 'Priority,was given-to Aensuring thatthepatient "was medically'stable and the injury was treat ed pri5r to treatment for the exposure to radiation. The patient was unwrappedfrorn the mummy'wrappings.. Care was given to rolling the outside of the sheet to the inside to-Contain any contamination thatmwas, present.

Medical treatment was administered. The-rnedical team.removed the neck brace and.

head pads used to stabilize the patient.T-These were surveyed by the IEMA RM and.

considered clean. The examination for neck and head for injuries resulted in no injuries found. The medical team cut off the sling used to stabilize the injured arm. A survey registered it as contaminated. It was secur'ed'in a hazardous material bag within the Decon Room. The,inj'ury site was viewed and the patient questioned for the location~and leve! of pain. There was no visible break or dislocation of the limb., There was n'o visible lacerations or bleeding. The area-was simulated as being swollen and bruised. The patient complained of stiffness and moderate pain. The IEMA RM surveyed the hands of the attending medical staff after the examination of the injured arm and contaminated gloves were removed and bagged. New, clean:gloves were'donned.

'13

I After the'medical assessment:was conducted, the IEMARM conducted a survey of the patient, The following radiation~readings were encountered and recorded: :-Forehead at hairline 1600 cpm; right palm 3000 cpm; right injured forearm 1200 cpm; right pant knee I

1500 cpm; left palm 1200 cpm; leftpant knee 1500 cpm; left pant cuff 2000 cpm. :The shoes were covered with booties.-The shoes were removed and bagged., The feet were surveyed-and were clear of contamination.. The clothing was cut and removed' using I

proper techniques to control the spread of contamination. The removed clothing was placed'in a contamination contmol bag. The IEMA RM surveyed the bag, for contamination; bag read 1300 cpm.-This bag was taken to the buffer zone monitor and I

properly; double bagged. Again the IEMA RM surveyed the exterior, of the second bag and found it -totbe clear of contamination. -The bag was labeled by-thebuffer-zone monitor~and processed for proper disposal. Medical.staff was monitored by the IEMA RM contaminated gloves were-removed and clean glovas donned.

Throughout the.Medical Center portion ýof the drill,_ monitoring of the patient was'.,

conducted in a low radiation background-area., The'patient was examined usirIg a..

Ludlum Model 2241-3 survey. instrument-equipped with a-pancake probe, speaker and.

set-able alarm. The monitoring techniques used were slow and. methodical,with properI positioning-of the probe for' personrOel monitoring:. As monitoring occurred,..

contamination. readings found on the-patienitwere verbally given to the bufferzone monitor, who recorded the information on the Medical Center's Radiological Accident I

Monitoring and Decontamination Form..

The IEMA RM effectively decontaminated *all.areas.i Using duct tape,.the palms were.-

decontaminated;-resurveyed and found -to-*,be clean-on the-first attempt;. The forehead.

was decontamiriated..first;.'using.iape and then with sterile water washes using surgical -

sponges; first attempt read 800 cpm, secondý attempt 40 cpm..-The injured arm was-decontaminated using-first using tape andithen a sterile-water wash;, using several, surgical sponges; first attempt.read 1000,cpm;,second.attempt 45 cpm.-Each used,.,

sponge was placed in,:'a",labeJ hazardous waslte-bag-after use-and the-area re-surveyed.

to determine the contamination, level,-,Thethird wash attempts resulted in successful

.decontamination.

All supplies used during treatment wereproperly disposed of in -a container marked with a hazardous.waste sign.,As a precautionary measure, the injury site was re-surveyed to

-ensure that, it had not become contaminated,: Periodically during the decontamination process, individual nurses would.req~uest th*at the IEMA RM survey their gloved hands-to ensure. that they were notspreading contamination, reinforcing their knowledge and awareness of radiological-contaminationcontrol.,--

The IEMA RM performed a complete survey~of the patient and-the gurney (wheels/bottom/sides) to ensure that it was clean. The patient was cocooned with clean sheets and was wheeled into the corridor for a final medical assessment by the ER physician. -This process was carried out slowly and-methodically as. themedical staff:

and the lEMA RM wanted to ensure that.no contamination haphazardly was-overlooked.

14

For demonstration purposesr, the IEMA RM performed a survey of one.Decon Room,

nurse as she exited the DeconRoom.. The nurse started out-by-removing the outer,.

gloves on both hands, rolling the outside.of the glovei.to.the inside during removal~and then putting the gloves into a hazmat waste container. The hands were surveyed and found clean. The face mask and hair covering were removed. The nurse removed her gown; rolling the outside to the inside, and' put the, gown in the hazmat container. -

The IEMA RM performed a slow and methodical full body surveywith the probe held about one-half to one inch away from the survey area. This was the same technique used for all survey-attempts conducted during the drill. The survey. started at the top of the head and moved down the right and backsidetof the torso. The.inside of the right, thigh and calf were surveyed. The.IEMA RM proceeded to the ihside-of the left thigh and calf and then up the left and backside of the torso'. The nurse then faced the. IEMA RM and the same process was used to survey the front of the torso. The nurse-then faced to exit the Decon Room. The IEMA RM surveyed the upper portion of.the doorway to determine a clean area for-the 'nurse to:have a' handhold while the booties and -shoes.were surveyed. The IEMA RM-instructed the nurse'toi remove the left bootie.

After this occurred,'the nurse's left foot was surveyed>., It was.found cleanand the nurse stepped out of the Decon Room onto a~clean.step off pad. This process was repeated.,

with the other~foot. Finally, the nurse was,tld, to take off the final pair of gloves'..-

The IEMA RM stated that he would follow the same proceduresbtO clear and release the rest of the medical team from the Decon Room. All hazardous wastes would be double bagged,:,labeled, sealed and properly.processed, for disposal. Afterwards,"he would survey the Decon Room for contamirrationil:.aying attentionto the door jam :and:. used equipment (gurney, backboard,; scissors;- stethoscope, etc)..A sweep of the floor,.

following a grid pattern would be,,usedoto cc[ear,:the Decoil Room. Ifcontamination was.

found:at, any spot,'a surface wipe-would bedonea.at the,.location and the.area would be resurveyed.".lf'an' area could, not be, decontarmihnated,; the Decon Room would be :closed off untilmore thorough'decontami'nation efforts could be performed., The -IEMA-RM would provide advice on waste disposal that would'be:provided to,him from State: or, IEMA officials.

The medical center's Radiological Sdpervisor.was:interviewed to determine what action would be taken: if there was a need to.ebtain 'technical-assistance with the handling, of radioactive contamination and contaminated patient care. The.Supervisor advised that if IEMA and State Radiological Eme'rgency*Assistance.Cehter,(REAC) could not provide the information that the Radiological Emergency.Assistance Center/Training Site (REAC/TS) located in Oak Ridge, Tennessee'; woulld'be contacted: The contact information was identified as being available on the REAC/TS Radiation Patient Treatment poster located on the wall.outside-of the.Decon Room-..

All activities described in the demonstration criterion were carried out in accordance.

,with the 'plan,, procedures and extent-of-play agreement.,

15

I Medical Services (MS-i) Hospital.-Saint James Hospital

a. MET: 1.d.1, 1.e.1, 3.a.1, 6.d.1.

b. AREAS REQUIRING CORRECTIVE ACTION: None c..DEFICIENCY: None

d. NOT DEMONSTRATED: None

e. PRIOR ISSUES - RESOLVED: None

f. PRIOR ISSUES - UNRESOLJED:, None 16

APPENDIX,. 1.

DRILL EVALUATORS AND TEAMi LEADERS DATE: 2009-07-14, SITE: Dresden. Nuclear Power Station, IL :

LOCATION EVALUATOR

~AGENCY Medical Services (MS-I) Transportation - Duffy Ambulance Clinton Crackel DHS/FEMA Service Medical Services (MS-I) Hospital - Saint James Hospital

• William Sulinckas DHS/FEMA T_~?eamLeader 17

APPENDIX 2 EVALUATION AREAS AND EXTENT PLAY AGREEMENT DRILL OF OFFSITE MEDICAL DRILL

ý OSF ST. JAMES MEDICAL CENTER:

PONTIAC, ILLINOIS I

I

.I I

I I

I I

I I

I I

I I

I I

I

'JULY 14,'2009 Start time: 9:00 a.m.

V 18 I

I

Zr,

~

EXTENT OF PLAY AGREEMENT FOR THE MEDICAL SERVICES EXERCISE July 14, 2009 Location:

OSF St. James Medical Center Transportation Provider: Duffy Ambulance 2500 West Reynolds Pontiac, IL 61764

Participants:

Victim (volunteer)

Lead Controller: (IEMA)

IEMA ER Monitor: Ed Stagen IEMA Hospital Controller* Kathy Allen IEMA Ambulance Monitor: Kelly Grahn JEMAAmbulance Controller: Joni Estabrook Criteria that can be re-demonstrated immediately for credit, at the discretion of the evaluator, include the following: For Transportation: 1-d 1., 3.aA and 6.d.1; for the Hospital, 1.d. 1, 1.e. 1, 3.a.1 and 6.d. 1. Criteria may be re-demonstrated, as agreed by the Lead Controller and FEMA Evaluators.

EVALUATION AREA 1-EMERGENCY OPERATIONS MANAGEMENT Criterion 1.d.1: At least two communioation sý-sioi are, available, at least one operates properly, and communication links are established and maintained With appropriate locations.

Communications capabilities are' managed insupp*A'tof emergency operations.

The Duffy Ambulance will use 2-way radios to communicate with OSF St. James. Other communication systems that can be used include commercial telephone or cell phones.

Criterion 1.e.l: Equipment, maps, displays, dosimetry, potassium iodide (KI) and other supplies are sufficient to support emergency. operations.

OSF St. James will adequately demonstrate the ability to support operations, with adequate resources. The availability of dosimetry and K1 for hospital personnel will not be demonstrated. during this exercise, however IEMA staff will be issued dosimetry and KI as field team members.

EVALUATION AREA 3 - PROTECTIVE ACTION IMPLEMENTATION Criterion 3.a.l: The OROs issue appropriate dosimetry and procedures, and manage radiological exposure to emergency workers in accordance with the plan and procedures.

Emergency workers periodically and at the end of each mission read their dosimeters and record the readings on the appropriate exposure record or chart.

The use of dosimetry and KI will not be demonstrated by hospital staff. IEMA staff will demonstrate appropriate use of dosimetry and KI.

19

For purposes of this exercise, if there is no medical need to bring equipment into and out of the treatment room, nasal swabs willbe taken (swabs to be taken outside the nose to simulate taking swabs inside the nose)* and passed out of the room to demonstrate movement of equipment and supplies into and out of the controlled area.

n EVALUATION AREA 6.d - TRANSPORTATION AND TREATMENT OF CONTAMINATED INJURED INDIVIDUALS Criterion 6.d.l: The facility/ORO has the appropriate-space, adequate resources, and trained personnel to provide transport, monitoring, decontamination, and medical services to contaminated injured individuals.

Duffy Ambulance will demonstrate the capability to transport contaminated, injured individuals to OSF St. James in Pontiac, Illinois. The ambulance crew will pick up a I

contaminated injured patient near the grounds of OSF St. James (simulating pick-up of a patient from Pontiac High School Reception Center). The ambulance crew will be met by IEMA staff that will perform initial radiation monitoring, and will provide information I

regarding contamination levels on the patient. Duffy Ambulance will utilize universal precautions and good housekeeping practices to minimize the spread of contamination, and will focus on treating the patient's medical condition.

l Duffy Ambulance will call in the information regarding the patient to OSF St. James in Pontiac so they can prepare for receipt of a contaminated patient. IEMA personnel will I

accompany the patient to the hospital along with the ambulance, bringing instrumentation to provide radiation readings and guidance to the hospital.

OSF St. James will implement their plan for receipt, isolation and treatment of an injured contaminated patient. Medical personnel will utilize universal precautions and good housekeeping practices to minimize the spread of contamination, and will focus on treating the patient's medical condition. Simple decontamination efforts will be demonstrated after the patient has been medically stabilized. The hospital will demonstrate procedures for limiting exposure to hospital staff, decontaminating a patient, and restricting access to the I

area where the patient is being treated and monitored. IEMA personnel will discuss the need to take additional samples for further radiological analysis. Hospital personnel will demonstrate their knowledge of who to call beyond IEMA for assistance in Radiological i

Accidents, e.g., REAC/TS.

For purposes of this exercise, another IEMA staff member will be dispatched to OSF St.

James with radiation detection and measurement equipment in advance of the ambulance arriving. The purpose of having two separate individuals for this exercise is to facilitate monitoring the ambulance and ambulance personnel so they are not kept out of service for an I

extended period of time.

The drill will conclude with the hospital representative and IEMA personnel supervising the removal of protective clothing and surveying of the emergency room and hospital personnel.

20 iI

IEMA will also advise on the proper procedure for release or disposal of contaminated material.

Following the conclusion of the drill, a 'short critique will be held.

i 2 1'

/