ML101940109

MS-1 Abridged Drill Report, After Action Report/Improvement Plan

ML101940109
Person / Time
Site:	South Texas
Issue date:	04/05/2010
From:	Federal Emergency Management Agency
To:	Office of Nuclear Security and Incident Response
References
Download: ML101940109 (48)

Text

South Texas Project After Action Report/

Improvement Plan Drill Date - March 11, 2010 Radiological Emergency Preparedness (REP) Program Published April 05, 2010

Unclassified Radiological Emergency Preparedness Program (REP)

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After Action Report/Improvement Plan South Texas Project South Texas Project After Action Report/Improvement Plan Published April 05, 2010 Contents Executive Summary 3 Section 1: Exercise Overview 4 1.1 Exercise Details 4 1.2 Exercise Planning Team Leadership 4 1.3 Participating Organizations 5 Section 2: Exercise Design Summary 6 2.1 Exercise Purpose and Design 6 2.2 Exercise Objectives, Capabilities and Activities 6 2.3 Scenario Summary 6 Section 3: Analysis of Capabilities 7 3.1 Drill Evaluation and Results 7 3.2 Summary Results of Drill Evaluation 7 3.3 Criteria Evaluation Summaries 10 3.3.1 Private Organizations 10 3.3.1.1 Matagorda County EMS 10 3.3.1.2 Palacios Community Medical Center 10 Section 4: Conclusion 12 Appendix A: Improvement Plan 13 Appendix B: Best Practices 14 Appendix C: Drill Evaluators and Team Leaders 15 Appendix D: Acronyms and Abbreviations 16 Appendix E: Exercise Plan 17 1

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After Action Report/Improvement Plan South Texas Project EXECUTIVE

SUMMARY

On March 11, 2010, an out-of-sequence medical drill was conducted for the South Texas Project (STP) located near Wadsworth, Matagorda County, Texas. Personnel from the U.S. Department of Homeland Security/Federal Emergency Management Agency (DHS/FEMA), Region VI, evaluated the drill. The purpose was to assess the level of preparedness of state and local responders to react to a simulated radiological emergency at STP. The previous medical drill at this site was conducted February 20, 2008. Personnel from Matagorda County Emergency Medical Services, Matagorda County Hospital District and Palacios Community Medcal Center, the Department of State Health Services, and STP participated in the drill.

Personnel from the Texas Department of State Health Services, South Texas Project, Matagorda County Emergency Medical Services, and Palacios Communicty Medical Center participated in the drill. Evaluation Areas demonstrated included: Emergency Operations Management, Protective Action Implementation, and Support Operations/Facilities. Cooperation and teamwork of all the participants was evident during these drills, and DHS/FEMA wishes to acknowledge these efforts.

This report contains the final written evaluation of this out-of-sequence drill. The participants demonstrated knowledge of their emergency response plans and procedures and adequately implemented them. There were no Deficiencies, one Area Requiring Corrective Actions (ARCA), and no Plan Issues identified during these drills.

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Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project SECTION 1: EXERCISE OVERVIEW 1.1 Exercise Details Exercise Name South Texas Project Type of Exercise Drill Exercise Date March 11, 2010 Program Department of Homeland Security/FEMA Radiological Emergency Preparedness Program Scenario Type Radiological Emergency 1.2 Exercise Planning Team Leadership Lisa Hammond RAC Chair FEMA Region VI Technological Hazards Branch Cheif 800 Norht Loop 288 Denton, Texas, 76209 940-898-5199 lisa.hammond@dhs.gov Nan Calhoun Federal Planning Team Lead FEMA Region VI Technological Hazards Program Specialist 800 North Loop 288 4

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After Action Report/Improvement Plan South Texas Project Denton, Texas, 76209 940-898-5398 nan.calhoun@dhs.gov Rae Walker State Exercise Planner Texas Department of State Health Services Emergency Planner P.O. Box 149347 Austin, Texas, 78714 512-834-6770 rae.walker@dshs.state.tx.us Lurinda Barton Utility Exercise Planner South Texas Project Emergency Planner P.O. Box 289 Wadsworth, Texas, 77483 361-972-7695 lsbarton@stpegs.com 1.3 Participating Organizations Agencies and organizations of the following jurisdictions participated in the South Texas Project drill:

State Jurisdictions Texas Department of State Health Services Risk Jurisdictions Palacios Community Medical Center Matagorda County Emergency Medical Services Private Organizations South Texas Project 5

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After Action Report/Improvement Plan South Texas Project SECTION 2: EXERCISE DESIGN

SUMMARY

2.1 Exercise Purpose and Design The DHS/FEMA Region VI Office evaluated the drill on March 11, 2010 to assess the capabilities of local emergency preparedness organizations in implementing their Radiological Emergency Response Plans and procedures to protect the public health and safety during a radiological emergency involving the South Texas Project (STP). The purpose of this report is to present the results and findings on the performance of the offsite response organizations during a simulated radiological emergency.

2.2 Exercise Objectives, Capabilities and Activities Exercise objectives and identified Capabilities/REP Criteria selected to be exercised are discussed in the Exercise Plan (EXPLAN), Appendix E.

2.3 Scenario Summary The drill scenario was developed to evaluate the response of drill participants to an incident at the South Texas Project requiring the transportation, treatment and decontamination of a radiologically contaminated injured individual. The drill scenario provided for the evaluation of the Matagorda County Emergency Medical Services and Palacios Community Medical Center staff .

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After Action Report/Improvement Plan South Texas Project SECTION 3: ANALYSIS OF CAPABILITIES 3.1 Drill Evaluation and Results Contained in this section are the results and findings of the evaluation of all jurisdictions and functional entities that participated in the March 11, 2010 drill to test the offsite emergency response capabilities of state and local governments in the 10-mile emergency planning zone (EPZ) surrounding the South Texas Project (STP).

Each jurisdiction and functional entity was evaluated on its demonstration of criteria contained in the exercise evaluation areas as outlined in the Federal Register, Vol. 67, No. 80, "FEMA-Radiological Emergency Preparedness: Evaluation Methodology" (April 25, 2002). Detailed information on the exercise evaluation area criteria and the extent of play agreements used in these drills is included as an appendix to this report.

3.2 Summary Results of Drill Evaluation The matrix presented in Table 3.1, on the following page, presents the status of all exercise evaluation area criteria that were scheduled for demonstration during the drill by all participating jurisdictions and functional entities. Exercise criteria are listed by number and the demonstration status is indicated by the use of the following letters:

M - Met (No Deficiency or Areas Requiring Corrective Actions [ARCAs] assessed and no unresolved ARCAs from prior exercises)

D - Deficiency assessed A - ARCA(s) assessed or unresolved ARCA(s) from prior exercise(s)

N - Not Demonstrated P - Plan Issue 7

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After Action Report/Improvement Plan South Texas Project Table 3.1 - Summary of Drill Evaluation Matagorda County EMS DATE: 2010-03-11 Palacios Medical SITE: South Texas Project, TX M: Met, A: ARCA, D: Deficiency, P: Plan Issue, N: Not Demonstrated Emergency Operations Management Mobilization 1a1 Facilities 1b1 Direction and Control 1c1 Communications Equipment 1d1 Equip & Supplies to support operations 1e1 M M Protective Action Decision Making Emergency Worker Exposure Control 2a1 Radiological Assessment and PARs 2b1 Decisions for the Plume Phase -PADs 2b2 PADs for protection of special populations 2c1 Rad Assessment and Decision making for the Ingestion Exposure Pathway 2d1 Rad Assessment and Decision making concerning Relocation, Reentry, and Return 2e1 Protective Action Implementation Implementation of emergency worker exposure control 3a1 M M Implementation of KI decision 3b1 Implementation of protective actions for special populations - EOCs 3c1 Implementation of protective actions for Schools 3c2 Implementation of traffic and access control 3d1 Impediments to evacuation are identified and resolved 3d2 Implementation of ingestion pathway decisions - availability/use of info 3e1 Materials for Ingestion Pathway PADs are available 3e2 Implementation of relocation, re-entry, and return decisions. 3f1 Field Measurement and Analysis Adequate Equipment for Plume Phase Field Measurements 4a1 Field Teams obtain sufficient information 4a2 Field Teams Manage Sample Collection Appropriately 4a3 Post plume phase field measurements and sampling 4b1 Laboratory operations 4c1 Emergency Notification and Public Info Activation of the prompt alert and notification system 5a1 Activation of the prompt alert and notification system - Fast Breaker 5a2 Activation of the prompt alert and notification system - Exception areas 5a3 Emergency information and instructions for the public and the media 5b1 Support Operations/Facilities Mon / decon of evacuees and emergency workers, and registration of evacuees 6a1 Mon / decon of emergency worker equipment 6b1 Temporary care of evacuees 6c1 Transportation and treatment of contaminated injured individuals 6d1 M A 8

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After Action Report/Improvement Plan South Texas Project 3.3 Criteria Evaluation Summaries 3.3.1 Private Organizations 3.3.1.1 Matagorda County EMS

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

b. AREAS REQUIRING CORRECTIVE ACTION: None

c. DEFICIENCY: None

d. PLAN ISSUES: None

e. NOT DEMONSTRATED: None

f. PRIOR ISSUES - RESOLVED: None

g. PRIOR ISSUES - UNRESOLVED: None 3.3.1.2 Palacios Community Medical Center

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

b. AREAS REQUIRING CORRECTIVE ACTION: 6.d.1.

ISSUE NO.: 60-10-6d1-A-01 CRITERION: Facility/ORO has the appropriate space, adequate resources, and trained personnel to provide transport, monitoring, decontamination, and medical services to contaminated injured individuals. (NUREG-0654, F.2., H.10., K.5.a.b.,

L.1., 4)

CONDITION: There was no physician present during the drill as is required by DHS-FEMA REP Program guidance. A physician was in contact with the Palacios Community Medical Center but was not phyiscally present to supervise or assist as required.

POSSIBLE CAUSE: Failure to follow the plan. The Matagorda Regional Medical Center Radiological Emergency Plan paragraph 5.4.1.2 requires the health care provider to ensure additional physician assistance is available to cover the emergency room. During the course of the drill, there was no physician physically present to provide this additional assistance or to supervise treatment of the contaminated injured patient.

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After Action Report/Improvement Plan South Texas Project

REFERENCE:

Krimm Memorandum "Clarification of Selected Provisions of Guidance Memorandum (GM) MS-1, Medical Services" dated February 9, 1988, and Interim REP Program Manual, August 2002,Section III.J - Evaluation of Emergency Medical Services Drills, page III-238.

EFFECT: The absence of the physician on site could result in a delay of advanced medical treatment for the patient if required.

RECOMMENDATION: Provide training to the medical center staff to ensure that a physician is physically present to supervise treatment of the contaminated injured patient as is required by the emergency plan and DHS/FEMA guidnace.

c. DEFICIENCY: None

d. PLAN ISSUES: None

e. NOT DEMONSTRATED: None

f. PRIOR ISSUES - RESOLVED: None

g. PRIOR ISSUES - UNRESOLVED: None 11

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After Action Report/Improvement Plan South Texas Project SECTION 4: CONCLUSION Based on the results of the drill, the offsite radiological emergency response plans and preparedness for the State of Texas and the affected local jurisdictions are deemed adequate to provide reasonable assurance that appropriate measures can be taken to protect the health and safety of the public in the event of a radiological emergency. Therefore, 44 CFR Part 350 approval of the offsite radiological emergency response plans and preparedness for the State of Texas site-specific to STP will remain in effect.

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After Action Report/Improvement Plan South Texas Project APPENDIX A: IMPROVEMENT PLAN Issue Number: 60-10-6d1-A-01 Criterion: 6d1 ISSUE: There was no physician present during the drill as is required by DHS-FEMA REP Program guidance. A physician was in contact with the Palacios Community Medical Center but was not phyiscally present to supervise or assist as required.

RECOMMENDATION: Provide training to the medical center staff to ensure that a physician is physically present to supervise treatment of the contaminated injured patient as is required by the emergency plan and DHS/FEMA guidnace.

CORRECTIVE ACTION DESCRIPTION: Same as recommendation. Matagorda County will train hospital staff to call a licensed Physician in the event there is a radiologically contaminated patient and will have them physically present at the next MS-1 exercise.

CAPABILITY: PRIMARY RESPONSIBLE AGENCY:

Medical Surge Matagorda County CAPABILITY ELEMENT: START DATE:

Personnel 2010-04-05 AGENCY POC: COMPLETION DATE:

Doug Matthes, Matagorda Co. EMC 979-323-0707 2012-04-05 13

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project APPENDIX B: BEST PRACTICES

1. Patient Contamination Diagram Summary: The RPT placed a piece of masking tape onto his wrist and drew a diagram of the contaminated patient's body noting areas and levels of contamination.

==

Description:==

At 1027, a second call was received at PCMC from STP stating that the patient was indeed contaminated. STP stated that the patient had contamination readings of 1000 counts per minute (cpm) on the right and left wrists, 800 cpm on the chest area, and 600 cpm on the forehead. The RPT placed a piece of masking tape onto his wrist and drew a diagram of the patient's body noting areas and levels of contamination.

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After Action Report/Improvement Plan South Texas Project APPENDIX C: DRILL EVALUATORS AND TEAM LEADERS DATE: 2010-03-11, SITE: South Texas Project, TX LOCATION EVALUATOR AGENCY Matagorda County EMS Brad DeKorte DHS/FEMA Palacios Community Medical Center Linda Gee DHS/FEMA

• Tim Pflieger DHS/FEMA

• Team Leader 15

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project APPENDIX D: ACRONYMS AND ABBREVIATIONS Acronym Meaning ARCA Areas Requiring Corrective Actions BZ Buffer Zone CN Charge Nurse CP Control Point cpm Counts Per Minute DHS/FEMA Department of Homeland Security/Federal Emergency Management Agency EMT Emergency Medical Technician EPD Electronic Personal Dosimeter ER Emergency Room ETA Estimated Time of Arrival GM Guidance Memorandum KI Potassium Iodide LCD Liquid Crystal Display MCEMS Matagorda County Emergency Medical Services PCMC Palacios Community Medical Center PPE Personal Protective Equipment REA Radiation Emergency Area RPT Radiation Protection Technician STP South Texas Project TLD Thermoluminescent Dosimeter 16

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project APPENDIX E: EXERCISE PLAN 17

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER 1.0 Scope and Participants The 2010 Palacios Community Medical Center MS-1 exercise will test and provide the opportunity to evaluate the plans and procedures utilized to respond to contaminated injuries. It will demonstrate the utilization of hospital, ambulance, and station procedures supporting emergency medical services.

Whenever practical, the exercise incorporates provisions for free play by the participants. The scenario simulates a sequence of events, which results in a medical accident with contaminated injuries. The degree of the simulated injuries requires immediate response by onsite and offsite emergency medical teams with offsite hospital support.

The scenario is sufficiently difficult to challenge participants; however, responses will be controlled to ensure the safety of personnel and plant equipment.

The exercise will be conducted with the following participants:

Exercise Participants STP Unit 1 Control Room (simulated via phone cell)

STP Radiation Protection STP Plant Protection (EMTs)

STP Emergency Response Division Matagorda County Emergency Medical Services (MCEMS)

Palacios Community Medical Center (PCMC) 18

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After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER 2.0 Exercise Evaluation Areas and Extent of Play The Evaluation Areas applicable to this exercise are taken from the Federal Emergency Management Agency (FEMA) Evaluation Area Criterion for Medical Exercises. The extent of play follows the criterion in these documents. Any exception to the Evaluation Area is noted with the Evaluation Area and extent of play.

EVALUATION AREA 1.e.1 - EQUIPMENT, MAPS, DISPLAYS, DOSIMETRY, POTASIUM IODIDE (KI), AND OTHER SUPPLIES ARE SUFFICIENT TO SUPPORT EMERGENCY OPERATIONS.

Instruments are operationally checked before use. Instruments are calibrated in accordance with manufacturers recommendations.

A label indicating calibration is on each instrument. Sufficient quantities of appropriate electronic personal dosimeters and permanent record dosimetry are available for issuance to all categories of emergency workers deployed by that facility.

Sufficient supplies, equipment, displays, and personal protective equipment are available.

Extent of Play Donning and doffing of personal protective equipment will be demonstrated by one player.

Correction on the spot is requested for purposes of dressing out for local agencies.*

EVALUATION AREA 3.a.1 - IMPLEMEMTATION OF EMERGENCY WORKER EXPOSURE CONTROL The Offsite Response Organizations (OROs) issue appropriate dosimetry and procedures and manage radiological exposure. Emergency Workers periodically and at the end of each mission read their dosimetry and record the readings on the appropriate exposure record or chart.

Extent of Play Correction on the spot is permitted with issues related to dosimetry use, reading dosimetry, alarm set points and record keeping. Correction on the spot is requested.*

EVALUATION AREA 6.d.1 - TRANSPORTATION AND TREATMENT OF CONTAMINATED INJURED INDIVIDUALS 19

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After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER The facility/ORO has the appropriate space, adequate resources, and trained personnel to provide transport, monitoring, decontamination, and medical services to contaminated, injured individuals.

Extent of Play Correction on the spot is permitted with issues related to the adequacy of vehicles, equipment, and procedures, decontamination techniques, cross contamination issues for personnel transporting and treating contaminated injured or exposed individuals. Correction on the spot is requested.*

Onsite Extent of Play Matagorda County EMS will be notified of the need to transport and treat a contaminated injured individual. Onsite medical responders will simulate initial treatment of the injured individual providing emergency care until the ambulance arrives to transport the injured individual to the hospital.

• Correction-on-the-spot is defined in FEMA Policy Paper, Strategic Review Steering Committee, Initiative 1.5, Correct Issues immediately, effective March 31, 2000, signed by Kay C. Goss, CEM, Associate Director for Preparedness, Training, and Exercises.

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After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER 3.0 Conduct and Evaluation The Exercise will simulate a medical emergency at the South Texas Project, which will demonstrate the effectiveness of communications with offsite organizations, personnel, and activities to support the Emergency Plan and associated procedures.

Controllers may provide clarification that is necessary for participants to understand the intent of the message given by the controller or on a message sheet.

The medical emergency response at the South Texas Project will be situated at a simulated location. The patient will be packaged at the Nuclear Training Facility by the onsite EMTs.

Matagorda County EMS is contacted to respond to the site for patient transfer to an offsite hospital.

A controller will be on the ambulance, to provide patient performance paths (vital signs) and contamination levels during the trip to the hospital.

The organization for this Exercise will consist of the Exercise Coordinator, Controllers, Evaluators, Participants, and Observers, as follows:

The Exercise Coordinator is responsible for the coordination and the safe conduct of the exercise. This individual will provide resolution to scenario-related questions and ensure that the conduct of the exercise does not adversely impact the operation of the station and/or offsite agencies actual emergency response activities.

The Controllers will deliver event condition messages to designated participants at specified times and places during the Exercise, including contingency messages, as required, to keep the Exercise moving according to the scenario timeline.

Controllers will also observe the scenario actions and prepare written evaluations of the Participants' performance. Controllers will be identified by wearing red badges labeled CONTROLLER.

The Evaluators will judge the effectiveness of participating organizations, personnel, and activities. Evaluators will be identified by wearing blue EVALUATOR badges.

The Observers will be authorized, on a limited basis, to watch Exercise activities for the purpose of personal education. Observers will be identified by wearing white OBSERVER badges.

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After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER In the event of an actual emergency during the conduct of the exercise, all exercise activities will be immediately halted and response directed to the actual event.

The Controller is responsible for immediately intervening and terminating any action during the conduct of the exercise that would place either an individual or a plant component in an unsafe condition.

All telephone communications, radio transmissions and public address announcements related to the exercise will begin and end with the statement THIS IS A DRILL.

While participants are expected to inject as much realism into their response actions as possible, safety of personnel and plant equipment shall not be jeopardized.

After the Exercise is complete, the Exercise Coordinator will conduct a critique session.

Potential issues with the emergency plan, procedures, training program, facilities, equipment, and/or other areas will be identified through the critique and evaluation process. The issues will be documented by the Exercise Coordinator and corrected by the individuals/organizations that have responsibility for the area of the identified issue(s).

4.0 Definitions Controller: A member of the exercise organization assigned to one or more activities for the purpose of keeping the action going according to a scenario, resolving scenario discrepancies, and ensuring the safe deliberation of actions by the participants. A controller evaluates and makes recommendations for improvement and recognizes above average performance.

Evaluator: A member of the exercise organization assigned to one or more activities to evaluate and make recommendations for improvement or recognition of above average performance.

Exercise: An event which tests and provides the opportunity to evaluate the plans and procedures utilized to respond to contaminated injuries. It will demonstrate the utilization of hospital, ambulance, and station procedures supporting emergency medical services.

Observer: An individual who is authorized to observe the exercise, but is not authorized to interact with the participants.

Participants:

All individuals assigned to perform functions of the emergency response organization as a participant in the exercise.

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After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER 5.0 References

1. Title 10, Code of Federal Regulations, Part 50, Appendix E

2. STP Emergency Plan

3. Matagorda County Hospital District Radiological Emergency Plan

4. NUREG-0654/FEMA-REP-1, Criteria For The Preparation And Evaluation Of Radiological Emergency Response Plans And Preparedness In Support Of Nuclear Power Plants

5. FEMA Evaluation Area Criterion for Medical Exercises

6. STP Plant procedure, Emergency Medical Response Plan (0PGP03-ZA-0106)

7. FEMA General Memorandum MS-1, Medical Services

8. STP Plant Procedure, 0POP04-ZO-0004, Personnel Emergencies 6.0 Controller Instructions Instructions:

Each Controller and Evaluator should be familiar with the following:

1. The applicable evaluation area and extent of play of the exercise.

2. The exercise conduct and evaluation guidelines and precautions.

3. The exercise scenario, including initiating events and expected course of action.

4. The facilities and locations that will be involved and the specific actions to be observed.

5. The evaluation checklists provided to document participant actions.

Controllers should be positioned at assigned locations at least 15 minutes prior to the activation of the facility or location.

Message sheet information should be delivered in sequence and as written, unless the Exercise Coordinator authorizes change.

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Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER Controllers may provide information to the participants regarding scenario progression or the resolution of problems encountered in the course of the simulated emergency.

Each Controller/Evaluator shall take detailed notes regarding the progress of the Exercise (i.e., a chronology) and the response of the participants.

The Lead Exercise Controller in conjunction with the FEMA Evaluator may delay, suspend or cancel the exercise if an emergency situation requires use of the ambulance, hospital ER or personnel.

Controllers/Evaluators should carefully note the arrival and departure times of participants.

Controllers/Evaluators should carefully note problem areas encountered and good practices. The chronology can be used to corroborate critique items that are questioned by participants. Refer to Attachment A for the Controller/Evaluator Forms.

Controllers for this Exercise shall include:

Exercise Coordinator STP Control Room Controller (simulated phone cell)

Palacios Community Medical Center Controller STP Emergency Medical Technician (EMT) Controller Radiation Protection Controller - Hospital Radiation Protection Controller - Ambulance 24

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER 7.0 Narrative Summary and Event Timeline The onsite narrative is provided as information to be used by controllers. Actual onsite response will occur at the South Texas Project on a limited basis. However, station EMTs and Radiation Protection personnel will be available to support offsite agency responses to the simulated medical emergency.

STP Unit 1 is in a refueling outage. An employee is working on the bridge of the refueling machine in the Fuel Handling Building. The employee slips on the bridge and falls into the spent fuel pool and hits her head. She is retrieved by co-workers and the onsite EMTs are called and respond to the scene.

The EMTs arrive, evaluate medical conditions and determine the injured worker needs to be transported to an offsite medical facility, as she is disoriented and has a bleeding gash on her eye and forehead. The EMTs contact the simulated Control Room to confirm the need for an ambulance to respond to the site for transfer to the hospital.

The simulated Control Room contacts Matagorda County Emergency Medical Services to request ambulance service to transport the potentially contaminated injured worker.

Matagorda Regional Medical Center will redirect the ambulance to the Palacios Community Medical Center due to the Matagorda Regional Medical Center being overwhelmed with patients from the collapse of the bleachers at the high school during a pep rally.

Radiation Protection evaluates radiological conditions and establishes contamination controls for the accident scene. All individuals that were on the bridge are contaminated and must go through personnel monitoring and decontamination.

The site ambulance will be maneuvered to a pickup point and await arrival of the injured individual from the MAB.

Once monitored by Radiation Protection, the injured worker is found to have 500 - 1000 cpm ()

on clothing and exposed skin (refer to Figure 10.0-1.) If the patients contaminated clothing is removed, skin contamination remains (refer to Figure 10.0-2.).

The worker is packaged, loaded on the site ambulance, and driven to the pick up location. They meet up with the offsite ambulance at the Nuclear Training Facility.

Upon arrival of the ambulance, STP EMTs provide a briefing to Matagorda County Emergency Medical Services crew regarding patient condition. A Radiation Protection technician 25

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER accompanies the patient and provides radiological information and contamination control. A second Radiation Protection technician is called out and directed to the PCMC.

In route, the hospital is appraised of the patient's physical and radiological condition.

Upon hospital arrival, the Radiation Protection technician and ambulance attendants brief the emergency room staff. Upon completion of the briefing, the attendants turn the injured worker over to emergency room staff care. The Radiation Protection technician, who travels with the ambulance stays with the vehicle to monitor, and decontaminate, if required. Prior to the release of the ambulance, the Radiation Protection technician will survey the crew and their equipment. Results of the survey are in accordance with Figure 10.0-5, Matagorda County EMS Radiological Survey.

A brief decontamination demonstration will be performed prior to releasing the ambulance.

The Radiation Protection technician, who responds, monitors the decontamination room, as well as performs contamination control duties and assists with decontamination, as necessary. (Refer to Figure 10.0-4 for Palacios Community Medical Center Radiological Survey and Layout).

The hospital staff provides initial treatment and decontamination. Medical treatment will take priority over contamination. Decontamination will be achieved with the assistance of the Radiation Protection technician. Once the patient is stabilized, treated, and decontaminated, the patient will be transferred out of the decontamination area using recognized transfer techniques for standard admittance to the hospital.

Once the patient is transferred, the hospital staff inside the decontamination area will carefully remove their protective clothing (with the support of the Radiation Protection technician) to ensure control of contamination.

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Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER MESSAGE TIME SEQUENCE OF EVENTS NUMBER 10:00 Initial conditions established. 1 10:05 The telephone cell implements storyboard information. 2 CONTROLLER NOTE Communications with offsite for support will be made to Matagorda County Emergency Medical Services.

10:10 Unit 1 Control Room (simulated phone cell) contacts Matagorda County 3 Emergency Medical Services at (979) 323-9020 and requests they respond for a transfer.

10:13 Matagorda Regional Medical Center re-directs the patient to PCMC for 4 treatment.

CONTROLLER NOTE For more information on the injured workers vital signs, refer to Table 10.0-1, Patient Performance Paths.

For more information on the injured workers radiological conditions, refer to Figures 10.0-1, Patients Contamination-with Clothing, and 10.0-2, Patients Skin Contamination.

10:40 Site EMT(s) provide patient status and turn over care to Matagorda County EMS. Radiation Protection provides radiological status of the patient.

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Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER MESSAGE TIME SEQUENCE OF EVENTS NUMBER 10:45 MCEMS contacts PCMC with known patient information 5 11:05 Matagorda County EMS arrives at PCMC with the patient.

11:08 Patient is met by medical staff and Radiation Protection at the unloading area for radiological status, medical briefing, initial treatment and decontamination.

11:15 Stabilization and decontamination of patient begins.

CONTROLLER NOTE For more information on patient contamination, refer to Figure 10.0-3, Patients Skin Contamination After Decontamination.

11:35 Matagorda County Emergency Medical Services personnel, vehicle, and equipment are monitored, decontaminated as needed, and released.

CONTROLLER NOTE For more information on ambulance radiological conditions, refer to Figure 10.0-5, Matagorda County EMS Radiological Survey.

11:45 Patient decontamination is complete.

11:50 Patient is moved from emergency room area for final treatment and hospital admittance.

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Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER MESSAGE TIME SEQUENCE OF EVENTS NUMBER CONTROLLER NOTE For more information on hospital radiological conditions, refer to Figure 10.0-4, Palacios Community Medical Center Radiological Survey and Layout.

12:00 Hospital personnel exit decontamination room. 6 Medical Exercise is terminated.

12:20 Critique begins.

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Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER 8.0 Controller Data and Messages This section provides Controllers with patient data and messages that will be needed to relay injured worker data to participants who are responding to the medical emergency. Patient contamination levels are provided based on clothes on or off, and if decontamination attempts have been made. Refer to Patient Contamination Information (10.0-1 through 10.0-3).

The patient medical information is as if full treatment is provided and the patient is responding well.

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Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER Figure 10.0-1, Patients Contamination - With Clothing 8.1 CPM 500 800 1000 1000 Front Back 31

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER Figure 10.0-2, Patients Skin Contamination CPM 500 200 400 450 Front Back 32

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER Figure 10.0-3, Patients Skin Contamination After Decontamination VICTIM CONDITION RADIOLOGICAL DATA IN CPM Clothes Survey Head 500 Back of the right arm 1000 Front of the right & left arms 1000 Chest 800 Skin Survey Head 500 Back of the left arm 450 Front of the left arm 400 Chest 200 After first decontamination attempt at Face As Read hospital Back of the left arm As Read Front of the left arm 400 Chest As Read After Second decontamination attempt at hospital All meter readings are as read NO DETECTABLE CONTAMINATION AFTER SECOND DECONTAMINATION ATTEMPT 33

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER Figure 10.0-4, Palacios Community Medical Centerl Radiological Survey and Layout Helicopter Pad r

Meditation Dining!

Administrative Room Conference Room CMPOOI!08C5 (08119102)

= CURBISIDEWALK e---------.

o

= Rad Barrier Rope

= Slep-Oll-Pad

= Rad Barrier Rope set up upon ambulance arrival

= Patient Route Location Activity CPM/100cm2 1 As Read 2 As Read 3 As Read 4 400 5 200 6 250 7 As Read 34

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER 8.2 Figure 10.0-5, Matagorda County EMS Radiological Survey 450cpm 450cpm 300cpm 300cpm 500cpm CDI03563 (02/10)

AMBULANCE ATTENDANTS ARE FOUND TO HAVE NO CONTAMINATION.

NO DETECTABLE CONTAMINATION ON AMBULANCE AFTER ONE DECON ATTEMPT.

Discuss with the evaluator, how much monitoring and decontamination will be required to be demonstrated. The numbers are based on a direct frisk. This survey is assumed to have been completed after patient transfer.

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Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER Table 10.0-1, Patient Performance Paths Approx. PATH A PATH B PATH C Time Treat for shock and Injuries treated, but is Victim is not treated for injuries not treated for shock shock or injuries 10:10 Initial assessment - Initial assessment - Initial assessment -

Site Disoriented, but somewhat Disoriented, but somewhat Disoriented, but somewhat responsive. Two inch responsive. Two inch responsive. Two inch laceration on the forehead, laceration on the forehead, laceration on the forehead, possible concussion. Wants possible concussion. Wants possible concussion. Wants to sleep. to sleep.. to sleep.

10:20 ABCs completed. Omission of oxygen & No treatment. Patient Site Pressure dressing applied to warming blanket - patient becomes unresponsive.

the laceration. Oxygen remains disoriented and is administered. Inline not responsive. Pressure cervical spine subligation dressing applied to the with application of cervical forehead.

collar. Patient log-rolled to place on backboard; patient is awake but confused, slowly responding to some commands. Patient is warmed with a blanket.

10:40 Patient is more alert, Patient is awake but groggy. Patient remains Turnover complaining of pain on unresponsive. Skin is cool forehead. and clammy.

10:50 Patient is stable, alert and Patient is awake but groggy Ambulance oriented complaining of pain on forehead.

11:00 Patient calm; but complains EMS personnel begin Ambulance of pain on forehead. treating patient for shock.

11:10 Patient calm; but complains Patient feels better, more Patient is stabilized.

Turnover of pain on forehead. alert.

11:15 Patient calm, but complains Patient is alert. Patient is responsive and Hospital of pain on forehead. becoming alert.

11:30 Patient complaining of pain Patient complaining of pain Patient complaining of pain Hospital during decontamination during decontamination during decontamination efforts. efforts. efforts.

11:45 Patient complains of pain Patient complains of pain on Patient complains of pain on Hospital on forehead. forehead. forehead.

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Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER Table 10.0-2, Patient Vital Signs PATH A PATH B PATH C Approx. Treat for shock and Injuries treated, but is Victim is not treated for Time injuries not treated for shock shock or injuries 10:10 RESP - 18 B/P - 138/78 Same as Path A. Same as Path A.

Site PULSE - 100, Regular/Strong SKIN - Warm/Moist GCS 13-14 PUPILS - Equal/Reactive 10:20 RESP - 17 B/P - 136/78 RESP - 22 B/P - 128/80 RESP - 24 B/P - 118/72 Site PULSE - 92, PULSE - 126, PULSE - 128, Regular/Strong Regular/Strong Regular/Strong SKIN - Warm/Moist SKIN - Warm/Moist SKIN - Warm/Moist PUPILS - Equal/Reactive PUPILS - Equal/Reactive PUPILS - Equal/Reactive 10:30 RESP - 17 B/P - 128/76 RESP - 28 B/P - 116/72 RESP - 29 B/P - 98/60 Site PULSE - 80, PULSE - 90, Pulse - 134, Regular Regular/Strong Regular/Strong SKIN - Cool/A little SKIN - Normal SKIN - Warm/Moist clammy PUPILS - Equal/Reactive PUPILS - Equal/Reactive PUPILS - Equal/Reactive Distal pulse is present, capillary refill is immediate.

10:40 Same as above. Same as above. Same as above.

Turnover GCS 14 10:50 RESP - 17 B/P - 130/80 RESP - 24 B/P - 120/75 RESP - 32 B/P - 90/55 Ambulance PULSE - 88, PULSE - 90, Regular PULSE - 150, Weak Regular/Strong SKIN - Warm Moist SKIN - Cool/Clammy SKIN - Normal PUPILS - Equal/Reactive PUPILS- Equal/Reactive PUPILS - Equal/Reactive 11:10 RESP - 17 B/P - 130/80 RESP - 24 B/P - 120/75 RESP - 32 B/P - 90/55 Turnover PULSE - 88, PULSE - 90, Regular PULSE - 140, Weak Regular/Strong SKIN - Warm/Moist SKIN - Cool/Clammy SKIN - Normal PUPILS - Equal/Reactive PUPILS- Equal/Reactive PUPILS - Equal/Reactive 11:15 RESP - 16 B/P - 125/90 RESP - 24 B/P - 125/70 RESP - 26 B/P - 100/60 Hospital PULSE - 95, PULSE -90, Regular PULSE - 120, Regular Regular/Strong SKIN - Warm/Moist SKIN - Cool/Clammy 37

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER GCS 15 SKIN - Normal PUPILS - Equal/Reactive PUPILS- Equal/Reactive PUPILS - Equal/Reactive 11:30 RESP - 14 B/P - 120/80 RESP - 18 B/P - 120/80 RESP - 20 B/P - 120/80 Hospital PULSE - 90, PULSE - 90, PULSE - 90, Regular Regular/Strong Regular/Strong SKIN - Cool A little SKIN - Normal SKIN - Normal clammy PUPILS - Equal/Reactive PUPILS - Equal/Reactive PUPILS - Equal/Reactive 11:45 Same as above. Same as Path A. Same as Path A.

(Hospital) 38

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER MESSAGE NO: 1 Page 1 of 1 THIS IS A DRILL To: All Participants and Controllers From: Controller Location: All Participants Time: 10:00 Initial conditions establish that the weather is as found on the day of the Exercise, however, is it extremely foggy in the area surrounding Houston and on the coast. Unit 1 is in a refueling outage and Unit 2 is as found.

(If inclement weather occurs move onsite portion of the exercise to the NSC under the front canopy) 39

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER MESSAGE NO: 2 Page 1 of 1 THIS IS A DRILL To: Onsite Players From: Onsite Controllers Location: All Time: 10:05 Controller Note: Communications with offsite support will be made to Matagorda County Emergency Medical Services.

A call has been made to the Unit 1 Control Room indicating a plant employee has been injured. Control Room staff in Unit 1 should implement procedure 0POP04-ZO-0004, Personnel Emergencies. STP medical responders should be called out to assess the scene and offer care to the patient.

When they get to the scene, they find an injured female who has fallen into the spent fuel pool and when extracted by co-workers, is found to have hit her head. She has a bleeding gash on her eye and forehead and is unresponsive, with a possible concussion. The STP EMT(s) should note that the injuries are severe enough to warrant transport to an offsite medical facility.

In the meantime, the patient will be packaged and transported out of the protected area for pickup.

A player/controller briefing should occur in the old Emergency Operations Facility with the following:

Radiation Protection (supervisor, players, controller)

EMTs Onsite controllers Victim Patient will be moved to the usual site transfer area (front of the Nuclear Training Facility), where the turnover to Matagorda County EMS will be made.

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Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER MESSAGE NO: 3 Page 1 of 1 THIS IS A DRILL To: Matagorda County Emergency Medical Services From: Control Room Phone Cell Controller Location: Phone Cell Time: 010:10 THIS IS A DRILL. This is STP Unit One Control Room. We have a female who fell about 3 feet into water. She has suffered injuries and requires immediate transfer to an offsite medical center. She is probably contaminated and has a possible concussion. If asked, tell them she has a 2 inch eye and forehead laceration. THIS IS A DRILL.

Matagorda County Emergency Medical Services - (979) 323-9020 (Dispatcher)

Matagorda Regional Medical Center Emergency Department - (979) 241-3315 Palacios Community Medical Center (361) 972-2511 - (Operator)

Controller note: Provide the Dispatcher with your phone cell callback number to prevent actual contact with the Units.

After contacting Matagorda Regional Medical Center (MRMC), MRMC should determine to re-direct the patient to the Palacios Community Medical Center, due to MRMCs emergency departments ongoing response to handling a mass casualty event (bleachers at the high school collapsed during a pep rally.)

41

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER MESSAGE NO: 4 Page 1 of 1 THIS IS A DRILL To: Matagorda Regional Medical Center From: Matagorda Regional Medical Center Controller Location: Matagorda Regional Medical Center Time: 010:13 The Matagorda Regional Medical Center Controller inserts this message when the Matagorda County EMS calls to let the hospital know that potentially contaminated injured patient is in route. Below is the reason for the re-direct.

Palacios Community Medical Center (361) 972-2511 Matagorda Regional Medical Center redirects the Matagorda County EMS crew to the Palacios Community Medical Center due to MRMCs emergency departments ongoing response to handling a mass casualty event (bleachers at the high school collapsed during a pep rally.)

42

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER MESSAGE NO: 5 Page 1 of 1 THIS IS A DRILL To: Palacios Community Medical Center From: Matagorda County Emergency Medical Services Location: En-route Time: ~ 10:45 (As patient information is known)

When the Matagorda County Emergency Medical Services (ambulance) contact the hospital, provide them with known patient information as listed below.

+ 10 Patient Information as provided by the EMT at the scene.

RESP: 18 B/P: 138/78 Pulse: 100, Regular/Strong Skin: Warm/Moist Pupils: Equal/Reactive Symptoms/injuries: falling and hitting head (e.g. concussion, bleeding laceration on face, etc.)

43

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER MESSAGE NO: 6 Page 1 of 1 THIS IS A DRILL To: All Players From: Lead Controllers Location: All Facilities Time: When medical emergency activities are concluded CONTROLLER NOTE Upon completion of medical emergency activities in your area/facility, read the following message.

The medical Exercise is now terminated.

Please organize the documentation generated by the exercise and fill out a player comment sheet.

Ensure your name is recorded on a player attendance sheet.

Restore the facilities to their original condition.

There will be a player critique beginning in the Hyett Conference Room at _______ (~ 20 minutes after the conclusion of the Exercise.)

Have hospital emergency department contact Matagorda County EMS and tell them where and when the critique will begin.

44

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER 9.0 Controller and Evaluator Organization and Assignments CONTROLLERS LOCATION NAME Lead Controller Lurinda Barton Matagorda County EMS / Scott Korenek Radiation Protection Ambulance Radiation Protection-Hospital Steve Horak Hospital-Medical Response Jessica Gann Hospital Buffer Zone Joe Enoch Accident Scene - Security / EMT Steve Johnson

Response

Unit 1 Control Room Max Keys 45

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project 2010 MS-1 MEDICAL EXERCISE PALACIOS COMMUNITY MEDICAL CENTER EVALUATION AREA ASSIGNMENTS Objective Location Controller 1.e.1: Equipment and Dosimetry MCEMS Korenek PCMC Enoch Horak 3.a.1:Emergency Worker Exposure Control MCEMS Korenek PCMC Enoch Horak 6.d.1: Transportation & Treatment MCEMS Korenek PCMC Gann Enoch Horak MCEMS = Matagorda County EMS PCMC = Palacios Community Medical Center 46

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan South Texas Project This page is intentionally blank.

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