ML19232A217

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Us Dept. of Homeland Security, Federal Emergency Management Agency - Transmittal of Final After Action Report/Improvement Plan for the Morrison Community Hospital, Radiological Emergency Preparedness Medical Services Drill, Held May 8, 2019
ML19232A217
Person / Time
Site: Quad Cities  Constellation icon.png
Issue date: 08/06/2019
From: Joseph J
US Dept of Homeland Security, Federal Emergency Management Agency
To:
NRC/RGN-III, State of IL, Emergency Management Agency
References
Download: ML19232A217 (34)
v • d • e


Text

Alicia Tate-Nadeau, Acting Director Illinois Emergency Management Agency 2200 South Dirksen Parkway Springfield, Illinois 62703

Dear Ms. Tate-Nadeau:

U.S. Department of Homeland Security Region V 536 South Clark Street, 6th Floor Chicago, IL 60605 FEMA AUG O 6 2019 Enclosed is the Final After Action Report/Improvement Plan for the Morrison Community Hospital, Radiological Emergency Preparedness Medical Services Drill, held on May 8, 2019.

There were no Findings or Issues identified as a result of this drill.

Based on the results of the exercise, the planning and preparedness for the State of Illinois and affected local jurisdictions provide reasonable assurance that appropriate measures can be taken to protect public health and safety. Therefore, Title 44 CFR Part 350 approval of the offsite radiological emergency response plans and preparedness for the State of Illinois remain in effect.

If you have any questions, please contact Sean O'Leary, Chair, Regional Assistance Committee, at (312) 408-5389.

Enclosure cc:

DHS/FEMA Headquarters NRC Region Ill Sincerely, James K. Joseph Regional Administrator NRC Headquarters Document Control Desk www.fema.gov

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Final After Action Report/

Improvement Plan Exercise Date - May 8, 2019 Radiological Emergency Preparedness (REP) Program Morrison Community Hospital Medical Services Drill Quad Cities Station

  • EMA Published July 16, 2019 FOR OFFICIAL USE ONLY I' RECEIVED AUG O 9 2019

UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan Quad Cities Station Morrison Community Hospital Medical Services Drill This page is intentionally blank 2

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I UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan Quad Cities Station Morrison Community Hospital Medical Services Drill Contents EXECUTIVE

SUMMARY

............................................................................................................................ 5 SECTION 1: Exercise Overview................................................................................................................ 7 1.1 Exercise Details........................................................................................................................... 8 1.2 Exercise Planning Team Leadership............................................................................................ 9 1.3 Participating Organizations........................................................................................................ 10 SECTION 2: Exercise Design Summary................................................................................................... 11 2.1 Exercise Purpose and Design..................................................................................................... 11 2.2 FEMA Core Capabilities and Exercise Objectives...................................................................... 11 SECTION 3: Analysis of Capabilities....................................................................................................... 14 3.1 Summary Results of Exercise Evaluation................................................................................... 14 3.2 Exercise Evaluation and Results................................................................................................ 15 Table 3.2.1 - Summary of Exercise Evaluation - State of Illinois..................................... 17 3.3 Jurisdictional Summary of Exercise Evaluation Results............................................................. 18 3.3.1 State of lllinois.................................................................................................................. 18 3.3.1.1 Trinity Medical Center - Medical Services -Transportation.................................. 18 3.3.1.2 Unity Point Health-Trinity Medical Center - Medical Services - Facility................ 18 SECTION 4: Conclusion............................................................ ;............................................................ 19 APPENDIX A: Exercise Evaluation Team............................................................................................... 20 APPENDIX B: Acronyms and Abbreviations........................................................................................... 21 APPENDIX C: Extent-of-Play Agreements............................................................................................. 22 3

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I UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan Quad Cities Station Morrison Community Hospital Medical Services Drill EXECUTIVE

SUMMARY

On May 8, 2019, the Department of Homeland Security (DRS), Federal Emergency Management Agency (FEMA) Region V Radiological Emergency Preparedness (REP) Program staff, evaluated a REP Medical Services (MS-1) Drill in the Emergency Planning Zone (EPZ) for the Byron Station.

Byron Station is located in Ogle County, Illinois, on a 1,288-acre site in Rockvale Township, approximately 3.7 miles south-southwest of the City of Byron and 2.2 miles east of the Rock River in Ogle County. The site is situated approximately in the center of the county in a predominantly agricultural area.

The purpose of the MS-1 Drill was to assess the capability of the local ambulance service regarding the treatment and transportation of a contaminated, injured individual to a medical facility and to assess the capability of the medical facility to receive, treat, and decontaminate the injured individual without spreading contamination. The MS-1 Drill was conducted in accordance with FEMA's policies and guidance from the State and local radiological emergency response plans and procedures.

Representatives from the State of Illinois Emergency Management Agency, Morrison Community Hospital, and the Morris Community Hospital Ambulance Service participated in this drill. These representatives demonstrated knowledge of their emergency response plans and procedures and successfully implemented them. The DHS/FEMA evaluation team identified no Findings or Plan Issues.

The DHS/FEMA wishes to acknowledge the efforts of the 16 individuals who participated in the drill and made it a success. The professionalism and teamwork of the participants was evident throughout all phases of the drill.

Executive Summruy 5

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UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Quad Cities Station Final After Action Report/Improvement Plan Morrison Community Hospital Medical Services Drill

l'--....:.___:; ________________

This page is intentionally blank Executive Summruy 6

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I UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan Quad Cities Station Morrison Community Hospital Medical Services Drill SECTION 1: Exercise Overview The DHS/FEMA's responsibilities in radiological emergency planning for fixed nuclear facilities include the following:

Taking the lead in off site emergency planning and in the review and evaluation of Radiological Emergency Response Plans (RERPs) and procedures developed by State and local governments; Determining whether such plans and procedures can be implemented on the basis of observation and evaluation of exercises of the plans and procedures conducted by State and local governments; Responding to requests by the U.S. Nuclear Regulatory Commission (NRC) pursuant to the Memorandum of Understanding between the NRC and FEMA dated December 7, 2015 (Federal Register, Vol. 82, No. 88, May 9, 2017); and Coordinating the activities of Federal agencies with responsibilities in the radiological emergency planning process:

o U.S. Department of Agriculture; o

U.S. Department of Commerce; o

U.S. Department of Energy; o

U.S. Department of Health and Human Services; o

U.S. Department of the Interior; o

U.S. Department of Transportation; o

U.S. Environmental Protection Agency; o

U.S. Food and Drug Administration; and o

U.S. Nuclear Regulatory Commission.

Representatives of these agencies serve on the DHS/FEMA Region V Regional Assistance Committee (RAC), which is chaired by DHS/FEMA.

The MS-1 Drill was conducted on May 8, 2019 and evaluated by DHS/FEMA to assess the capabilities of State and local offsite emergency preparedness organizations in implementing their RERPs and procedures to protect the public's health and safety during a radiological emergency involving the Byron Station. The purpose of this exercise report is to present the exercise results and findings on the performance of the Off-Site Response Organizations (ORO) during a simulated radiological emergency.

The findings presented in this report are based on the evaluations of the Federal evaluation team, with final determinations made by the DHS/FEMA Region V RAC Chair and approved by the DHS/FEMA Headquarters.

The criteria utilized in the FEMA evaluation process are contained in:

NUREG-0654/FEMA-REP-1, Rev. 1, "Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness in Support of Nuclear Power Plants," November 1980;and FEMAP-1028 REP Program Manual, dated January 2016.

Section 1: Exercise Overview 7

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UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan 1.1 EXERCISE DETAILS EXERCISE NAME Quad Cities Station Morrison Community Hospital Medical Services Drill 2019 Radiological Emergency Preparedness Medical Services Drill TYPE OF EXERCISE Medical Services (MS-1) Drill EXERCISE DATE May 8, 2019 LOCATIONS Morrison Community Hospital, Morrison, Illinois SPONSORS Illinois Emergency Management Agency 2200 South Dirksen Parkway Springfield IL 62703 Exelon Corporation 4300 Winfield Road Warrenville, IL 60555 PROGRAM Department of Homeland Security/Federal Emergency Management Agency Radiological Emergency Preparedness Program MISSION

Response

SCENARIO TYPE Radiological emergency with a contaminated, injured individual Section 1: Exercise Overview 8

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I UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan Quad Cities Station Morrison Community Hospital Medical Senrices Drill 1.2 EXERCISE PLANNING TEAM LEADERSHIP Sean O'Leary Chair, Regional Assistance Committee Chief, Technological Hazards Branch DHS/FEMA Region V 536 South Clark Street Chicago, Illinois 60605 312-408-5389 sean.oleary@fema.dhs.gov Stephen Tulley Exercise Director DHS/FEMA Region V Supervisory Team Leader 536 South Clark Street Chicago, Illinois 60605 312-408-4425 step hen. tulley@fema.dhs.gov David Persaud Site Specialist DHS/FEMA Region V 536 South Clark Street, 7th Floor Chicago, Illinois 60605 312-408-5583 david.persaud@fema.dhs.gov William Conway Manager, Program Enhancement Bureau of Operations Illinois Emergency Management Agency 2200 South Dirksen Parkway Springfield, Illinois 62703 217-785-9986 william.conway@illinois.gov Michael Muth Off-Site Programs Exelon Corporation 4300 Winfield Road Warrenville, Illinois 60555' 779-231-1258 michael.muth@exeloncorp.com Section 1: Exercise Ovenriew 9

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UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan Quad Cities Station Morrison Community Hospital Medical Services Drill 1.3 PARTICIPATING ORGANIZATIONS Agencies and organizations of the following jurisdictions participated in the exercise:

STATE ORGANIZATIONS Illinois Emergency Management Agency (IEMA)

PRIVATE ORGANIZATIONS Morrison Community Hospital Morrison Community Hospital Ambulance Service Exelon Corporation FEDERAL ORGANIZATIONS Federal Emergency Management Agency Section 1: Exercise Overview 10 FOR OFFICIAL USE ONLY I

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I UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan Quad Cities Station Morrison Community Hospital Medical Services Drill SECTION 2: Exercise Design Summary 2.1 EXERCISE PURPOSE AND DESIGN The Department of Homeland Security (DHS), Federal Emergency Management Agency (FEMA) administers the Radiological Emergency Preparedness (REP) Program pursuant to the regulations found in Title 44 Code of Federal Regulation (CPR) parts 350, 351, and 352. Title 44 CPR Part 350 names 16 planning standards that form the basis for radiological emergency response planning for state, tribal, and local governments impacted by the EPZs established for each nuclear power plant site in the United States. Title 44 CPR Part 350 sets forth the mechanisms for the formal review and approval of state, tribal, and local government radiological emergency response plans and procedures by FEMA. One of the REP Program requirements established by these regulations is the biennial exercise of off site response capabilities. During these exercises, FEMA evaluates state, tribal, and local government plans, procedures, and actions to protect the health and safety of the public in the event of a radiological emergency at the nuclear plant.

The DHS/FEMA provides a statement with the transmission of this Final After Action Report/Improvement Plan to the United States NRC that the affected state, tribal, and local plans and preparedness are: (1) adequate to protect the health and safety of the public living in the vicinity o( the nuclear power facility by proviqing reasonable assurance that appropriate protective measures can be taken offsite in the event of a radiological emergency; and (2) capable of being implemented. The report and statement are based on the results of this exercise, review of the radiological emergency response plans and procedures, and verification of the periodic requirements set forth in "Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness in Support of Nuclear Power Plants,"

November 1980 (NUREG-0654/FEMA-REP-1, Rev. 1) through the annual letter of certification and staff assistance visits.

Formal submission of the radiological emergency response plans for the Byron Station to FEMA Region V by the State of Illinois, Rock Island County, and Whiteside County occurred on March 28, 1982.

Formal approval of these RERPs was granted by FEMA on September 12, 1984, under 44 CPR 350.

2.2 FEMA CORE CAPABILITIES AND EXERCISE OBJECTIVES Core Capabilities-based planning allows for exercise planning teams to develop exercise objectives and observe exercise outcomes through a framework of specific action items. Using the Homeland Security Exercise and Evaluation Program methodology, the exercise objectives meet the Radiological Emergency Preparedness Program requirements and encompass the emergency preparedness evaluation areas. The critical tasks to be demonstrated were negotiated with the State of Illinois. The Core Capabilities demonstrated during this exercise were:

Operational Coordination: Mobilize all critical resources and establish and maintain a unified and coordinated operational structure and process that appropriately integrates all critical stakeholders and supports the execution of Core Capabilities. Mobilize all critical resources and establish command, control, and coordination structures within the affected community, in other coordinating bodies in surrounding communities, and across the Nation, and maintain as needed throughout the duration of an incident. Enhance and maintain command, control, and coordination structures consistent with the National Incident Management System (NIMS) to meet basic human needs, stabilize the incident, and transition to recovery.

Section 2: Exercise Design Summary 11 FOR OFFICIAL USE ONLY

UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan Quad Cities Station Morrison Community Hospital Medical Services Drill Environmental Response/Health and Safety: Conduct appropriate measures to ensure the protection of the health and safety of the public and workers, as well as the environment, from all-hazards in support of responder operations and the affected communities. Identify, assess, and mitigate worker health and safety hazards, and disseminate health and safety guidance and resources to response and recovery workers. Minimize public exposure to environmental hazards through assessment of the hazards and implementation of public protective actions. Detect, assess, stabilize, and clean up releases of oil and hazardous materials into the environment, including buildings/structures, and properly manage waste.

Identify, evaluate, and implement measures to prevent and minimize impacts to the environment, natural and cultural resources, and historic properties from all-hazard emergencies and response operations.

Critical Transportation: Provide transportation (including infrastructure access and accessible transportation services) for response priority objectives, including the evacuation of people and animals, and the delivery of vital response personnel, equipment, and services into the affected areas. Establish physical access through appropriate transportation corridors and deliver required resources to save lives and to meet the needs of disaster survivors. Ensure basic human needs are met, stabilize the incident, transition into recovery for an affected area, and restore basic services and community functionality.

Clear debris from any route type (i.e., road, rail, airfield, port facility, waterway) to facilitate response operations.

Mass Care Services: Provide life-sustaining and human services to the affected population, to include hydration, feeding, sheltering, temporary housing, evacuee support, reunification, and distribution of emergency supplies. Move and deliver resources and capabilities to meet the needs of disaster survivors, including individuals with access and functional needs. Establish, staff, and equip emergency shelters and other temporary housing options (including accessible housing) for the affected population. Move from congregate care to non-congregate care alternatives and provide relocation assistance or interim housing solutions for families unable to return to their pre-disaster homes.

Public Health, Healthcare, and Emergency Medical Services: Provide lifesaving medical treatment via Emergency Medical Services and related operations and avoid additional disease and injury by providing targeted public health, medical and behavioral health support, and products to all affected populations.

Deliver medical countermeasures to exposed populations. Complete triage and initial stabilization of casualties and begin definitive care for those likely to survive their injuries and illnesses. Return medical surge resources to pre-incident levels, complete health assessments, and identify recovery processes.

Public and Private Services and Resources: Provide essential public and private services and resources to the affected population and surrounding communities, to include emergency power to critical facilities, fuel support for emergency responders, and access to community staples (e.g., grocery stores, pharmacies, and banks) and fire and other first response services.

The Core Capabilities and their associated Evaluation Criteria selected for demonstration by the jurisdictions establish the assessment objectives for the exercise. These Core Capabilities, when successfully demonstrated, meet the exercise objectives.

The objectives for this exercise were as follows:

Objective 1: Demonstrate the ability to provide direction and control and make protective action decisions through the state emergency operations centers, county emergency operations centers, and field activities by exercise play and discussion of plans and procedures.

Objective 2: Demonstrate the ability to make protective action decisions affecting state and county emergency workers and the public through exercise play and discussion of plans and procedures.

Section 2: Exercise Design Summazy 12 FOR OFFICIAL USE ONLY I

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I UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Quad Cities Station Final After Action Report/Improvement Plan *i Morrison Community Hospital Medical Services Drill Objective 3: Demonstrate the ability to implement protective actions for state and county emergency workers and the public through exercise play and discussion of plans and procedures.

Objective 4: Demonstrate the ability to monitor, decontaminate, register, and shelter evacuees through exercise play and discussion of plans and procedures.

Objective 5: Demonstrate the capacity for timely communications in support of security, situational awareness, and operations in accordance with the plan, procedures, and Extent-of-Play Agreement, among and between affected communities in the impact area and all response forces.

Objective 6: Demonstrate the capacity to stabilize critical infrastructure functions, minimize health and safety threats, and efficiently restore and revitalize systems and services to support a viable, resilient community. Demonstrate the capacity to provide transportation (including infrastructure access and accessible transportation services) for response priority objectives, including the evacuation of people and animals, and the delivery of vital response personnel, equipment, and services into the affected areas.

Collectively, these six Objectives successfully demonstrated the Core Capabilities and Evaluation Criteria selected by the jurisdictions in accordance with NUREG-0654/FEM-REP-l and the REP Program Manual (FEMA P-1028, dated January 2016).

Section 2: Exercise Design Summary 13 FOR OFFICIAL USE ONLY

UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan Quad Cities Station Morrison Community Hospital Medical Services Drill SECTION 3: Analysis of Capabilities 3.1

SUMMARY

RESULTS OF EXERCISE EVALUATION This section provides a combined assessment of state and local jurisdictions based upon their collective demonstrated performance under the core capabilities associated with the exercise evaluation criteria described in Appendix E, Extent-of-Play Agreements. It employs an integration of the Homeland Security Exercise Evaluation Program and REP Program evaluation methodologies - an analytical process used to assess the demonstration of specific capabilities during an exercise. A capability provides a means to perform one or more critical tasks under specified conditions and to specific performance standards. Core capabilities form the foundation of the National Preparedness System. The REP Program evaluation criteria provide the conditions and performance standards for establishing reasonable assurance that State and Local authorities can protect public health and safety in response to a nuclear power plant accident.

An overall summary of demonstrated capabilities is presented in Section 3.2, Table 3.2.1 of this report.

Criteria-specific narrative summaries are presented in a separate document entitled Morrison MS-1 Narrative Summaries. The narratives summarize observations made pursuant to the REPP Evaluation Criteria used to assess the organizations and locations that were selected by the State of Illinois. The organizations, locations, and evaluation criteria selected by the State of Illinois are described in Appendix E, Extent-of-Play Agreements, which were approved by DHS/FEMA on April 10, 2019.

The results 9f the assessment are summarized below by Core Capability, as demonstrated during the May 8, 2019, Morrison Community Hospital Medical Services Drill.

Operational Coordination: Mobilize all critical resources and establish and maintain a unified and coordinated operational structure and process that appropriately integrates all critical stakeholders and supports the execution of Core Capabilities. Mobilize all critical resources and establish command, control, and coordination structures within the affected community, in other coordinating bodies in surrounding communities, and across the Nation, and maintain as needed throughout the duration of an incident. Enhance and maintain command, control, and coordination structures consistent with the National Incident Management System (NIMS) to meet basic human needs, stabilize the incident, and transition to recovery.

Environmental Response/Health and Safety: Conduct appropriate measures to ensure the protection of the health and safety of the public and workers, as well as the environment, from all-hazards in support of responder operations and the affected communities. Identify, assess, and mitigate worker health and safety hazards, and disseminate health and safety guidance and resources to response and recovery workers. Minimize public exposure to environmental hazards through assessment of the hazards and implementation of public protective actions. Detect, assess, stabilize, and clean up releases of oil and hazardous materials into the environment, including buildings/structures, and properly manage waste.

Identify, evaluate, and implement measures to prevent and minimize impacts to the environment, natural and cultural resources, and historic properties fi;om all-hazard emergencies and response operations.

Critical Transportation: Provide transportation (including infrastructure access and accessible transportation services) for response priority objectives, including the evacuation of people and animals, and the delivery of vital response personnel, equipment, and services into the affected areas. Establish physical access through appropriate transportation corridors and deliver required resources to save lives and to meet the needs of disaster survivors. Ensure basic human needs are met, stabilize the incident, Section 3: Analysis of Capabilities 14 FOR OFFICIAL USE ONLY I

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I UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan Quad Cities Station Morrison Community Hospital Medical Services Drill transition into recovery for an affected area, and restore basic services and community functionality.

Clear debris from any route type (i.e., road, rail, airfield, port facility, waterway) to facilitate response operations.

Mass Care Services: Provide life-sustaining and human services to the affected population, to include hydration, feeding, sheltering, temporary housing, evacuee support, reunification, and distribution of emergency supplies. Move and deliver resources and capabilities to meet the needs of disaster survivors, including individuals with access and functional needs. Establish, staff, and equip emergency shelters and other temporary housing options (including accessible housing) for the affected population. Move from congregate care to non-congregate care alternatives and provide relocation assistance or interim housing solutions for families unable to return to their pre-disaster homes.

Public Health, Healthcare, and Emergency Medical Services: Provide lifesaving medical treatment via Emergency Medical Services and related operations and avoid additional disease and injury by providing targeted public health, medical and behavioral health support, and products to all affected populations.

Deliver medical countermeasures to exposed populations. Complete triage and initial stabilization of casualties and begin definitive care for those likely to survive their injuries and illnesses. Return medical surge resources to pre-incident levels, complete health assessments, and identify recovery processes.

Public and Private Services and Resources: Provide essential public and private services and resources to the affected population and surrounding communities, to include emergency power to critical facilities, fuel support for emergency responders, and access to community staples (e.g., grocery stores, pharmacies, and banks) and fire and other first response services.

The Core Capabilities and their associated Evaluation Criteria selected for demonstration by the.

jurisdictions establish the assessment objectives for the exercise. These Core Capabilities, when successfully demonstrated, meet the exercise objectives.

3.2 EXERCISE EVALUATION AND RESULTS This section contains the results and findings of the evaluation of all jurisdictions and functional entities that participated in the December 4, 2018 Partial-Participation Plume Exposure Pathway Exercise and out-of-sequence interviews and demonstrations.

Each jurisdiction and functional entity was evaluated based on their demonstration of Core Capabilities and their equivalent Radiological Emergency Preparedness Evaluation Criteria, as delineated in the Federal Emergency Management Agency Radiological Emergency Preparedness Program Manual dated January 2016. Exercise criteria are listed by number, and the demonstration status of those criteria are indicated by the use of the following terms:

1. M: Met (no unresolved Level I or Level 2 findings were assessed, and there were no unresolved findings from prior exercises)
2. Level I Finding was assessed
3. Level 2 Finding was assessed or an unresolved Level 2 finding(s) from a prior exercise
4. P: Plan Issue was assessed
5. ND: Not Demonstrated
6. NS: Not Selected (the Criterion was not selected for demonstration)

Section 3: Analysis of Capabilities 15 FOR OFFICIAL USE ONLY

UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Quad Cities Station Final After Action Report/Improvement Plan Morrison Community Hospital Medical Services Drill This page is intentionally blank Section 3: Analysis of Capabilities 16 FOR OFFICIAL USE ONLY I

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I U NC LASS I FIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan Quad Cities Station Morrison Community Hospital Medical Services Drill Table 3.2.1 - Summary of Exercise Evaluation - State of Illinois DA1E: May 8, 2019 SI1E: Byron Station

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Emergency Operations Management Mobilization lal Facilities lbl Direction and Control lcl Communications Equipment ldl Equipment and Supplies to Support Operations lel M

M Protective Action Decision-Making EW Exposure Control Decisions 2al PARs 2bl PADs 2b2 P ADs for Disabled/Functional Needs 2cl Ingestion P ADs 2dl RRR Decisions 2el EW Exposure Control Implementation 3al M

M KI Public/Institutionalized 3bl PAD Implementation Disabled/Functional Needs 3cl PAD Implementation Schools 3c2 TACP Establishment 3dl Impediments 3d2 Implement Ingestion P ADs 3el Ingestion Pathway Decisions 3e2 Implementation of RRR Decisions 3fl Field Measurement and Analysis I

RESERVED 4al Field Team Management 4a2 Field Team Operations 4a3 Field Team Sampling 4bl Laboratory Operations 4cl Emergency Notification and Public Info J.

l Initial Alert & Notification Sal RESERVED 5a2 Backup Alert & Notification 5a3 Exception Area Alerting 5a4 Subsequent Information & Instructions 5bl Support Operations and Facilities Reception Center Operations 6al EW Monitoring & Decontamination 6bl Congregate Care 6cl Contaminated lniured 6dl M

M Section 3: Analysis of Capabilities 17 FOR OFFICIAL USE ONLY

UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan Quad Cities Station Morrison Community Hospital Medical Services Drill 3.3 JURISDICTIONAL

SUMMARY

OF EXERCISE EVALUATION RESULTS The following sections present narrative summaries that describe observations made during the exercise pursuant to the Evaluation Criteria and Core Capabilities demonstrated at each jurisdiction's response locations. Narrative summaries are organized by Jurisdiction, Location, Assessed Core Capability, and the Evaluation Criterion discussed in the Appendix E Extent-of-Play Agreements. The results of the assessments are summarized in Table 3.2.1.

3.3.1 State of Illinois 3.3.1.1 Trinity Medical Center - Medical Service - T Criterion 1.e.1-Core Capability: Environmental Response/Health and Safety Core Capability: Mass Care Services Core Capability: Public & Private Services and Resources Core Capability: Public Health and Medical Services Criterion 3.a.1-Core Capability: Operational Coordination Core Capability: Environmental Response/Health and Safety Criterion 6.d.1-Core Capability: Critical Transportation Core Capability: Mass Care Services 3.3.1.2 UnityPoint Health-Trinity Medical Center - Medical Services - F Criterion 1.e.1-Core Capability: Environmental Response/Health and Safety Core Capability: Mass Care Services Core Capability: Public & Private Services and Resources Core Capability: Public Health and Medical Services Criterion 3.a.1-Core Capability:* Operational Coordination Core Capability: Environmental Response/Health and Safety Criterion 6.d.1-Core Capability: Critical Transportation Core Capability: Mass Care Services In summary, the status of DHS/FEMA-evaluated core capabilities and criteria for the State of Illinois is as follows:

  • 'MET: All Core Capabilities and Evaluation Criteria identified in the DHS/FEMA-approved extent-of-play agreement.

LEVEL 1 FINDINGS: NONE LEVEL 2 FINDINGS: NONE PLAN ISSUES: NONE PRIOR ISSUES - RESOLVED: NONE PRIOR ISSUES - UNRESOLVED: NONE Section 3: Analysis of Capabilities 18 FOR OFFICIAL USE ONLY I

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I UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan Quad Cities Station Morrison Community Hospital Medical Services Drill SECTION 4: Conclusion There were no Findings or Plan Issues identified for the State of Illinois.

Based on the results of the MS-1 Drill, the planning and preparedness for the State of Illinois and affected local jurisdictions provide reasonable assurance that appropriate measures can be taken to protect public health and safety. Therefore, Title 44 CFR Part 350, approval of the offsite radiological emergency response plans and preparedness for the state of Illinois, remains in effect.

Section 4: Conclusion 19 FOR OFFICIAL USE ONLY

UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan Quad Cities Station Morrison Community Hospital Medical Services Drill APPENDIX A: Exercise Evaluation Team EXERCISE DATE: May 8, 2019 SITE: Morrison Community Hospital - Byron Station i

Agency/

Exercise Management I )'. ".!-j.

Name On!anization Chair, Regional Assistance Committee Sean O'Leary DHS/FEMA Exercise Director Stephen Tulley DHS/FEMA Illinois Site Specialist David Persaud DHS/FEMA I,

Evaluated Off-Site Response Evaluator Agency/

Organizations/Locations Organization State of Illinois Morrison Community Hospital - Medical Service - Transportation Kimberly Alahmadi DHS/FEMA Morrison Community Hospital - Medical Services - Facility Brian Reinhart DHS/FEMA Appendix A: Exercise Evaluation Team 20 FOR OFFICIAL USE ONLY I

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I UNCLASSIFIED Radiological Emergency Preparedness (REP) Program Final After Action Report/Improvement Plan Quad Cities Station Morrison Community Hospital Medical Services Drill APPENDIX B: Acronyms and Abbreviations ACRONYM DESCRIPTION

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AAR After Action Report CDT Central Daylight Time CFR Code of Federal Regulation cpm counts per minute DCO Dosimetry Control Officer DLR Dosimeter of Legal Record DRD Direct-Reading Dosimeter ECL Emergency Classification Level EPZ Emergency Planning Zone EW Emergency Worker FEMA Federal Emergency Management Agency IEMA Illinois Emergency Management Agency IL Illinois IPRA Illinois Plan for Radiological Accidents KI potassium iodide MRT Medical Radiation Technician ND Not Demonstrated NIMS National Incident Management System I

NRC Nuclear Regulatory Commission NS Not Selected ORO Off-Site Response Organization PPB Personal Protective Equipment RAC Regional Assistance Committee I

REA Radiation Emergency Area REP Radiological Emergency Preparedness RERP Radiological Emergency Response Plan RRG Radiological Response Group RT Radiation Technologist Appendix B: Acronyms & Abbreviations 21 FOR OFFICIAL USE ONLY

UNCLASSIFIED Radiological Emergency Preparedness (REP) Program After Action Report/Improvement Plan Byron Station APPENDIX C: Extent-of-Play Agreements Appendix: B: Acronyms & Abbreviations 22 FOR OFFICIAL USE ONLY I

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I UNCLASSIFIED Radiological Emergency Preparedness (REP) Program After Action Report/Improvement Plan Byron Station ILLINOIS EMERGENCY MANAGEMENT AGENCY Offsite Medical Drill Extent of Play and Injects for Byron Medical Services Drill Morrison Community Hospital Morrison, Illinois Appendix C: Extent-of-Play May 8, 2019 Start time 1:00 p.m.

23 FOR OFFICIAL USE ONLY

UNCLASSIFIED Radiological Emergency Preparedness (REP) Program After Action Report/Improvement Plan Extent of Play Agreement Medical Services Exercise May 8, 2019 Location: Morrison Community Hospital 303 North Jackson Morrison, IL 61270 Transportation Provider: Morrison Ambulance Participant Roster:

Patients #1 adult patient #2 adult Lead Controller: IEMA Ambulance Controller: Joni Estabrook Hospital Controller: Tolly Knezevich Medical Radiation Technician: Rob Deters Byron Station Criteria that can be re-demonstrated immediately for credit at the discretion of the evaluator include the following: For Transportation: l.d.l, 3.a.l and 6.d.l; for the Hospital l.d.l, Le.I, 3.a.l and 6.d.l. Criteria may be re-demonstrated, as agreed by the Lead Controller and FEMA.

EVALUATION AREA 1-EMERGENCY OPERA TIO NS MANAGEMENT Criterion l.d.l: At least two communication systems are available, at least one operated properly, and communication links are established and maintained with appropriate locations.

The Ambulance will use 2-way radios to communicate with Morrison Community Hospital.

Other communication systems that may be used include commercial telephone or cell phones.

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

Morrison Community Hospital will adequately demonstrate the ability to support operations, with adequate resources. Morrison Community Hospital will also issue dosimetry and perform a dosimetry control briefing to staff prior to drill start.

Appendix C: Extent-of-Play 24 FOR OFFICIAL USE ONLY I

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I UNCLASSIFIED Radiological Emergency Preparedness (REP) Program After Action Report/Improvement Plan Byron Station EVALUATION AREA 3 - PROTECTIVE ACTION IMPLEMENJ;A. TION Criterion 3.a.l: The ORO's issue appropriate dosimetry, and procedures, and manage radiological exposure to emergency workers in accordance with the plan/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.

EVULAUTION AREA 6.d-TRANSPORTATION AND TREATMENT OF CONTAMINATED INJURED INVIDUALS 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.

Scenario and Background

==

Introduction:==

An off site medical drill will be conducted to demonstrate the State of Illinois' concept of operations of handling contaminated injured individuals. The drill is structured to address MS, 1 Hospital and Transportation Criteria.

Extent,of Play:

The Byron Station has declared a general emergency. 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 and her daughter who has reported to the reception center from a rural area and spent an extended time in the Quad Cities Station EPZ. The drill will begin at the pickup of the patient and parent by the ambulance. Any reception center activities will be observed and evaluated at the reception center demonstration. The walking well patient presenting in registration will be evaluated by the hospital to assist in planning efforts to update the plan.

Hospital and Transportation:

The hospital will demonstrate procedures for limiting exposure to hospital staff, decontaminating a patient, and restricting access to the area where the patient is being treated and monitored.

Morrison Ambulance will demonstrate the capability to transport a contaminated, injured individual( s) to Morrison Community Hospital. The ambulance crew will pick up a contaminated injured patient near the hospital at a simulated reception center. IEMA staff will be available to accompany the ambulance staff during the transportation portion of the drill.

Appendix C: Extent-of-Play 25 FOR OFFICIAL USE ONLY

UNCLASSIFIED Radiological Emergency Preparedness (REP} Program After Action Report/Improvement Plan Byron Station Morrison Ambulance will call in the information regarding the patient to the hospital, so they can prepare the receipt of a contaminated injured patient. Morrison Community Hospital 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 area where the patient is being treated and monitored. Hospital personnel will demonstrate their knowledge of who to call beyond IEMA for assistance in Radiological Accidents, e.g.,

REAC/TS.

One IEMA MR T will be available to participate in this drill. The IEMA MR Tis' available to facilitate hospital staff in monitoring the parent of the patient, ambulance staff and ambulance itself so it can be put back into service as soon as possible.

The drill will conclude with hospital nuclear medicine s~aff supervising the removal of protective clothing and surveying of the emergency room and hospital personnel. The IEMA MRT will be available to facilitate contamination control and decontamination efforts if needed.

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

Objectives:

1.

Demonstrate the ability of EMS personnel to transport a contaminated injured patient.

2.

Demonstrate the ability of hospital personnel to treat a contaminated injured patient.

3.

Demonstrate the ability of personnel to exercise proper radiological controls and issuance of dosimetry.

4. Demonstrate the proper techniques of personnel decontamination.
5. Demonstrate proper communication between medical personnel and IEMA staff.
6. Demonstrate proper use of radiation detectors.

IEMA Players and Controllers Injured Victims (#1 adult patient, #2 adult)

IEMAMRT IEMA Ambulance Controller IEMA Hospital Controller Appendix C: Extent-of-Play 26 FOR OFFICIAL USE ONLY I

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I U NCI.ASSIFIED Radiological Emergency Preparedness (REP) Program After Action Report/Improvement Plan Byron Station Extent of Play for Morrison Community Hospital Byron Station has declared a general emergency. 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 two residents who had stayed in the EPZ when the release occurred.

This drill will originate near the hospital at a simulated reception center.

1.

An ambulance and EMS staff will be used to demonstrate loading, transporting and unloading the victim. EMS personnel will pick up the patient at a staged location close to the hospital. The patient will be pre~staged for the ambulance arrival. IEMA staff will not be present for the transportation portion of the drill.

2. The ambulance crew will communicate with the receiving hospital regarding the medical status of the patient and any additional precautions taken to prevent spread of contamination.
3.

Hospital staff will be providing radiological exposure control and monitoring of EMS and hospital personnel. IEMA assistance will be provided, if needed.

4. Decontamination is determinant on ambulance protocols and injury that the patient presents.
5. Hospital personnel will be responsible for any patient and staff radiological monitoring and contamination control activities, duties may change over if IEMA becomes available to be dispatched.
6. IEMA staff in coordination with Morrison Hospital staff will supervise the ingress and egress of radiological control areas. Monitoring will be performed prior to personnel leaving the potentially contaminated patient treatment area. Protective clothing used by hospital personnel will be similar to that used for a chemical or biological agent in accordance with hospital protocol. Multiple methods of decontamination, including dry, damp or wet, may be utilized for the removal of contamination.
7.

The medical facility will demonstrate or describe their procedures for the medical treatment and necessary decontamination of a contaminated injured individual. Multiple methods of decontamination, including dry, damp or wet, may be utilized for the removal of contamination.

Hospital personnel will survey the hospital REA and medical personnel to maintain

  • contamination control. These methods may include taking wipes of floors and surfaces so that the hospital and ambulance can be cleared for normal operations.
8. The hospital may need to contact REAC/TS to determine appropriate samples needed to assess internal contamination. Any samples collected will be sent to REAC/TS for analyzing, IEMA does not process biological samples.
9.

Emergency medical personnel will be able to maintain their exposure below the limits specified in 10 CFR Part 20 because for the exercise, the dose rate from the patient is below 2 mr/hr.

10. After the hospital is notified, hospital personnel will prepare the area to receive the patient in accordance with their procedures and provide security as necessary. IEMA as a general practice would, if necessary, post radiation signs in accordance with the requirements as set forth in 10 CFR Part 20. Hospital security will control the area in accordance with the same policies and procedures used to provide isolation in the treatment of a chemical or biological agent.
11. Regardless of specific written hospital procedures for addressing radiation contamination, the supervision and advice provided by IEMA personnel should be the governing guidance for determining whether the patient's contamination situation is appropriately addressed.
12. The contaminated injured patient will be accompanied by a parent and infant that needs to be monitored. The pediatric and infant decon will be an objective to be performed and evaluated by the hospital, per hospital request.

Appendix C: Extent-of-Play 27 FOR OFFICIAL USE ONLY

UNCLASSIFIED Radiological Emergency Preparedness (REP) Program After Action Report/Improvement Plan Byron Station

13. After monitoring and decon has occurred the patient will utilize the decon room for final shower purpose.

The drill terminate when the controller verifies that the criteria under Evaluation Area 6, Sub~element 6.d.l and Evaluation Area 3, Sub~element 3.a.l, have been satisfied.

Appendix C: Extent-of-Play 28 FOR OFFICIAL USE ONLY I

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I UNCLASSIFIED Radiological Emergency Preparedness (REP) Program After Action Report/Improvement Plan MESSAGE FORM

() Controller (X) Player Drill/Exercise Type: Morrison Community Hospital Message for: Victim #1 adult patient and #2 adult spouse and EMS staff MESSAGE Byron Station TIME: Pre t = 0 Victim Instructions

( ) Contingency The Quad Cities Nuclear Power Station has issued a public broadcast that a radioactive release has.

occurred and that the residents and those working or residing in the Quad Cities EPZ area are being evacuated.

Before evacuating you and your spouse spend extended time in the EPZ during the release, which delays you in reporting to the reception center. You have been exposed and contaminated with low levels of radioactive materials. Upon arrival at the reception center your spouse falls and starts bleeding in one arm and has glass embedded in her wrist limiting the mobility of your fingers. The reception center staff notifies 911.

FOR CONTROLLERS USE ONLY The information would be available to the hospital as they received preliminary notification information from outbound ambulance calls.

Appendix C: Extent-of-Play 29 FOR OFFICIAL USE ONLY

UNCLASSIFIED Radiological Emergency Preparedness (REP) Program After Action Report/Improvement Plan Byron Station MESSAGE:

TIME: TimeO Initial Conditions MESSAGE FORM (X) Controller (X) Player

( ) Contingency DrilVExercise Type: Morrison Community Hospital Medical Drill Message for: Hospital Personnel and Nuclear Medicine Staff MESSAGE Initial Conditions:

Contamination Levels:

Initial FirstDecon Second Decon ThirdDecon survey Readin!I Right palm**

700cpm 500cpm 300cpm 75cpm Left palm**

600cpm 300cpm 60cpm Pant legs at both knees 500cpm Should be removed Shoes ( should be 900cpm 0 should be removed) removed

  • Pant/shoes should be removed and bagged.
    • Contamination would likely be spread from hand to other parts of the patient's skin or clothing from child to parent. Contamination levels on #1 adult patient will be driven by her interaction with t/:.2 adult Current Medical Conditions:

Complaining of pain in wrist, 5 out of 10 scale, conscious, alert pulse present, bleeding or other obvious signs of injury.

FOR CONTROLLERS USE ONLY Appendix C: Extent-of-Play 30 FOR OFFICIAL USE ONLY I

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I UNCLASSIFIED Radiological Emergency Preparedness (REP) Program After Action Report/Improvement Plan TO:

FROM:

First Responders/EMS EMS Controller Byron Station NOTE: Do not provide the data to players unless the means to obtain it are demonstrated.

THIS IS A DRILL DO NOT initiate actions affecting safe operations Message: male patient complaining of wrist pain, bleeding and numbness. Patient has allergy to penicillin.

EMS Arrival on Scene Enroute to Hospital InREA Level of ResponsiveX3 consciousness:

Respirations:

24 Pulse:

65 Skin:

Dry Blood Pressure:

140/74 110/70 100/68 Visual:

Note:

  • Patient condition en route and in REA are dependent on EMT actions and level of training.
  • Allergy to penicillin Expected Action:

Follow local protocols or standing orders.

THIS IS A DRILL DO NOT initiate actions affecting safe operations Appendix C: Extent-of-Play 31 FOR OFFICIAL USE ONLY

UNCLASSIFIED Radiological Emergency Preparedness (REP) Program After Action Report/Improvement Plan Byron Station TIME: 0 + 5 min.

MESSAGE: _____ _

MESSAGE FORM (X) Controller (X) Player

() Contingency DrilVExercise Type: Morrison Community Hospital Medical Drill Message for: Hospital Personnel MESSAGE When the hospital is notified that a potentially contaminated patient will be arriving, if the hospital has not already, they should make preparations to receive patient in accordance with hospital procedures.

FOR CONTROLLERS USE ONLY ED controller may inject, with permission of Evaluator, a time jump to expedite REA preparedness.

Appendix C: Extent-of-Play 32 FOR OFFICIAL USE ONLY I

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I UNCLASSIFIED Radiological Emergency Preparedness (REP) Program After Action Report/Improvement Plan Byron Station TIME: After patient arrival at hospital MESSAGE: Decontamination Activities MESSAGE FORM (X) Controller

() Player

( ) Contingency Drill/Exercise Type: Morrison Community Hospital Message for: IEMA RAD Controllers MESSAGE If proper radiological controls are in place no contamination is found in the ambulance. All areas of the hospital and path from ambulance to treatment room will be surveyed and read as background.

The controller may adjust contamination levels based on actions of the players.

The patient has contamination on right palm, left palm, pant knees and shoes. The spouse has contaminated shoes and one contaminated hand that was held by pediatric patient. Contamination levels and locations will be adjusted at the discretion of the controller.

IT DOES NOT MA TIER IF THE CLOTHING IS REMOVED BY THE AMBULANCE OR HOSPITAL PERSONNEL Clothing should be bagged and labeled.

FOR CONTROLLERS USE ONLY Appendix C: Extent-of-Play 33 FOR OFFICIAL USE ONLY

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