ML20004F951

Requests Info on Whether Ability of Hospitals to Evacuate Would Be Appropriate Consideration Under Condition of Court Ruling

ML20004F951
Person / Time
Site:	Crane
Issue date:	04/21/1981
From:	Gerard Jackson AFFILIATION NOT ASSIGNED
To:	Rambo S U.S. DISTRICT COURT, MIDDLE DISTRICT OF PENNSLYVANIA
References
NUDOCS 8106260334
Download: ML20004F951 (5)

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The Honorable Sylvia H. Rambo.

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Dear Judge:

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This latter la for the purpose of requesting information.

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/p Several months ago your court made an important ruling relative to the 8

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owners of the Three Mile Island !!udicar Potice Station.. It is my fund for the purpose recollection that part of that decision ee *W auA a

of rascarch on the impact of accidents at TMI_.

. There are many of us in the H3alth Care Delivery Field who since March of 1979 have been ccacerned about the ability of hospitals to be evacuated if required to do so by the governor's office. As you will recall, our hospitals were on stand by alert to be evacuated within four to eight hours of notification.

There is reason to believe that our institutions would not be able to cceply particularly with regard to those patients on lifetst.pport systems when tha evacuation is mandated by surface means. Although this matter has been of great concern to many organizations and many individuals, two y. ars have i

now clapse'd since the events 'which triggared this concern and to data no effective stud: of this problem Ms been menneed. To the best of my knowledge no such study is conte:nplated.

1 This lotter therefore is for the purpose of determining if this subject is one which might be considered appropriate under the ecndition. of the ruling of your court. - If so, could you please advice the mechanism j

by vbich one shculd initiate a request for censideration of this subject.

e Thank you. sincerely for your help, 63 Sincerely, 5

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. Jackson, M.D.

I oc J Senanko Bob Eall Jon Anderscts f.arry crow 11 E~#'

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Spacicl Cc;r.wdccMcn County OEP of a controlled on.eite adi-eti ai * = =""

Three Mileisland. >

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- 6 first 48 hours5.555556e-4 days <br />0.0133 hours <br />7.936508e-5 weeks <br />1.8264e-5 months <br /> of the incident, the

., e M, / ;.v..; x. public was informed that everything-2

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The Sile,..nt Disaster q "

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. at & plant.was under controi: th.

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on Friday, evidence to the contrary J Stanley Smith, Jr, MD, James H. Flaher..g l. ]q. .. jg.,

came over the news wire services.The e

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r *; y,7 *C (Nuclear-Regulatory Commission e From Wednesday, March 28,1979; to Wednesday, April *4,'-1979, (NRC) was sending a special emissary j

Dauphin County, Pennoyivenia, wee in a state of neer penlo in response to to TMI, and Walter Cronkite was the Three MUs.leland nuclear accident., The Dauphin County Office of, talking about s possible "m'elt.down" l **

gmergency Preparedness quickfy attempted to develop a plan to. evacuate. occurringin Harrisburg.Pa.Pennsyl-

.'vania Governor Richard Thornburgh not only the population of an area 20 miles in radfue from the plant but the recommended thst all pregnant wom-short. term and long-term care medical facilities as well. For medical-evacuet.on, a eyetem of classification of patients wee defined and matched - en and preschool sged children with-t, te needed treneportation. Furthermore, e critical coordinating link wee'. in a 6. mile radius of TMI relocate outside the endangered zone, and peo.

established with the Hospital Aseectation of Pennoyivente to Idant!!y and categorise relocation beds in receiving hospitals f ar from the incident efts la pie voluntarily began evacuating.

the event of eweeustion. Just as thle incident was unuouai, so too were the Outgoing roads became jammed, gas

'linee seemed longer than those eApe-gd planning activittee unique. since they were never be ' ore (conoefved or -. n ',.

rienced during the recent foot crisis, f

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Jand commercial flights out of Harris-l cc o. ' O'..... burg ~ International Airport were (JAAfA 1981;2'5:16661669) '

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.m ih,,'es%.7:u' side of Er'egida.

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. booked solid.

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, Following notification from. the ON MARCH.28,1979,'the potential' V

for the worst peacetime nuclear dis-Previously when hospitals were evac.

PEML Dauphin and surrounding.

sotar ever recorded surfaced In usted, & patients were moved. to _ York, I.ancaster, and Cumberland central Pennsylvania,when & Thru temporary shelters within'the disas- -counties began pr'epsrst!an for a.:

Mlle Island Nuclear Generating Sta-ter area, but' that wouldinot 'sufRee Initial 5-mile evacuation involving tion (TMI) experieneed a malfunction for a radiation leak.

~ i more than 25.000 residents. The very of its cooling system, allowing.!eak-Therefore, the problem we faced next. teletyped communication re -

l age of radiation to the environment.. was how to. evacuate, orderly and-ceived from PEMA.ca Friday, March During the malfunction and subee*

peacefully, nearly 200,000 residents;. 30,. ordered.h endengered eeunties quently over +he next three days, including those in the short. term and to plan for"evacuationvf

• reaa both i

serious problems arose with, the. long. term care medical facilities of, 10 and 20 miles from thodocident -

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i' nuclear core that could haveled to the. the county. This task liocame.W e. site...

evacuation of b surrounding area's.. responsibility of the Dauphin County. With 'all of ;Dau;:hla' County's '

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populace.

Of!!ce of Einergency Properedness short4 term care ' hospitals and a

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The offending agent was radiation, (OEP) (formerly Civil Defene.e)..The - majority of Ita long. term c:re m<J.

l which served only to cause panie job oi ; evacuating'short. term care cal facilities being contal ed within j

ha*=a.a it could not be seen, felt, or:. patients from hospitale'was delegated. 6:10 mile-perimeter, tl.e 'meciaal sensed ia any way. Suddenly, Harris ' lto the county's medical coordinator,i command team advixd thew !: cili-burg,and Middletown, Pa, became JamesH. Fisher. A medical ce-smand ties to begin preparatic.: for psst.iMe known worldwide, as emergency plan-team was formed, consisting ef Fisk - evacuation!' Aftar furtasr cadia in-nors mrt to deal with any cantin.- 'er; 13tanley Smith, Jr MD,2Jo. S.

acu=:4:nonis that the ace!::: !::f-sency.

Grottenthalct, Pennsylvania. Eaer-t dont had gone critical, t!.: fear hoep-I

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'We de not propose to discuss the. gency' Health Servlees Ceee.eil di-tais (Harrisburg Hospital, Pohelinie d

incid:nt nor h proe or cons of recter; and. Harrisburg Hospital Medkal Center, Community Ge:ceal nuclear power, but now that the inci. ambulatory. care.. director,dJohn H.

Oeteopathic Hospital, and the Har-I dont is ever, we must share our - Semanko.. The medicali command. shey Medical Center), in consuitation t

erperiences and lend our knowledge team's responsibilities during. the with 'h councy's menilesi command j

to others who may someday face a TMI incident included noth! cation. team, voluntarily started to reduce and coordination of.CS ambulance J hir patient eensus.Rhile this deei-l similar situaties. The unique aspect In our experience natalled planning to services and.h development of.a sion was met with' mixed emotiens erneuste numerous hospitalised pa-plan to evacuate the four shert. term from the hospital-mediesi st:ds care hospitals t.nd 15 lent. term care because there was as yet no de-

.F facilitica la Dauphin County.-

clared*' emergener, tha facinths be-

%,,,,,,is u.a.a ce mr. mes,.ei.e.

On Wedne:: day, March 2% 19D. the gan-to dischst::e as many pti:sts a:

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. resor.nen.a som cons,es vennn.ru, cme nrst day of the incident, the hnnsyl-possible, placa restricti e5 ca dl hat l

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vania Emer;er.cy Management Ages,. emergency admissions,ica can::t ci!

Cy- (PEMA) noGiled

'1.4 0.u;>his elective surgery and'disgasstic test-s.

n PA IFf to (Dr s,uusmp.

Isso JAMA. pru 24,1081-Vol 245 No.. f 5

" Three M6le lefand-Smith 4 Fisher 5

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t Time.

" County Hosoita's Dates Patruit C! ass Hosetal and Telephone No.

Total Ambulance Truck Bus Hospital A Medical /Surycal Hospital 8 Hospital C Hospital A Pediatne Hospital 8 i

Hosptal C Hosetal A i

intensrve Care Unit / Coronary Care Unit Hospital 8 Hospital C.

Hospital A Intermediate Hospital 8 Hosptal C Hospitsi A

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Matermty' Hospital 8 i

Hospital C Hosetal A.

Neonatal Hospital 8 Hospital C

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• b Hospital Pabent Color Coding: Blue (Ambulance Cases)

Blue /81eck (Ambulance With Lifersupport Equipment)

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Green (Trucks-Litters and Beds)

Wilow (Sus-Aesbulatory and vmeelchair)

Red (Discharge-8us f* Needed)

' Note: In Eyent of Evacuation-Hospitat A Errargency Care Unit to Aernain CDen UNTIt.

Evocuate of Medical Facilities is Complete.

' Mothers and Neweerns Count as M.

Fie t -Transport etetve torre for etese*cetion et patient typee, oeunty hospitade.

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cessful in reducing patient census to a team. Patients were first clasei6ed On Friday morning, March 30, low of 621 short term ears patients on into types, le, medical / surgical, ob-there were 1,308 short term care April 4, which is recognized as the stetrie/gynecologie, pediatrie, neona.

pitients within the four hospitale and last day of the crisis; howper, a senee tal, intensive care, and intermediate 2,400 nursing home patients to pre-of urgency cornpeted with the feeling care. These patient groups were fur-pare for' evacuation. The complexity of uncertainty during this task. -

ther subdivided by ths required mode.

l cf care varied from ambulatory to To prepare further the remaining ie, ambulance, ambular,ce with life-total-body support;in addition, there patients for evacuation, the hospital support squipment including moni-were approximately 30 outpatier:ta nursing staffs coded patients' charts tsrs sad respirators, truch for requiring renal dialysis on a regular to correspond with the tra:1 sport sta-patients requiring special handling (eg, St.yke: frames), and husca for basis.

tus according to a patie grouping The hospitals were extremely suc-supplied by the medical command ambulatory or partially ambulator 3 JAMA. Apr61 24, 1481-Vol 246, No.16 Three Mile Islersd-Semth & Fisher 1851' I

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s patients (Fig I and 2).

'our arAa.

metwith an exce!!ent response.owinz l

e Ttus, to facilitata rapid processing, During this planning process, a new in part to the cooperation ano com-color codes were assigned to the prnblem arose-the exodus of p.ople muaal spirit emanating from the patient categories 'and modes of : Included physleians, nurses, r.nd teh-facilities during its preparation.

.transportationc These colored strips.nlclans required to sL.E both tne To maintain current status, each were applied to both the patient short-term and long-term care medi-facFity nursing director was asi.ed to wristbands and their charts. Debar-cal facilities. Not only would the e,nduct a census and patient clusui.

kation areas corresponding to each of census be reduced at the facilities, but cation every 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> and report this f

'the color codes wwe also established

• at the same time, stad shortages information to the medical comma.'l 12 each Ir spital to allow faster load-would become critical Three lonr.

team. This information was then t

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Ing. StaK as !gnments were also term care iacilities (Frey Villa 2e, O dd coordinated with the availability of made to correcpond with the color Fellows, and Homeland) had to be reestving hospital beds and transpor-codes.Thus,la the event of an evacua.. relocated solely on the basis of tation. Additionally, everv 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> tion, both patients and stas could unavClable stas. Reduction of pa-a reassessment of the numbus and proceed to the appropriate cobred tient census by more than 50%,

types of receiving hospital beds was requests for oN. duty pusonnel, per-made.

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3 4t this point, a critical cardinst-sonnel willing'to work in some cases The medical command team also I;g link was establishad with the s.ound the e!ock, and cor.coIIdstion of riesigested two hospital emergency Hospital Association of Pennsylvania nursing units seemed temporarily to departments that would remain open (HAP).The HAP was able to identify relieve the immediate critical stag during the evacuation process to reenive emergency cases. On comples receiving hospitals to accept the Mar-

shortage, risburg-ares patients based on our The medical wacuation plans were tion of the county evacuation, these patient clanniReations. These receiv-presented to the administrative, med-emergency departments would be Ing hospitals extended for an area ical, and nursing stags of each short-cloed and the responsibility of pro-more than 100 miles long sad at least term and long-tum care medical viding further emwrency services 50 miles from the incident site (FJg 3).

facility. An additional' request was wouM be turned ovw to the PEMA Unlike in previous disasters," re-made also that stad members be for tisse few remaining in the evacu-llance could not be placed on tempo-assigned to accompany patients to the stica zone.

I rary s sitors within the danger sone, receiving' hospitals since they would Planz!ng during this period of so the decision was made to evacuate be ovwburdened by the sudden influx unceran3nty continued vigorously.

,' to short. term care. facilities outside of short-term care patients. The plan even artsugh we had 'no definitive word 3 rom the govuno i oSce on 3

s Times the imident status. Fins fter sev-

' ' - County Nursine Home i

Date cn daan from the ir!tia.

.cnt,the goverusr placed our plas. ang erforts Home Total Arrbufance Truck Bus on half, with his announcement that schooln outside the 5-mile radius would-be allowed to reopen. The gov-ernor further t.dvised emergency Telephone No.

workets to return to standby status.

fe *h The einergency was not clearly a rer.

E.. $~. @,f,G ge.S J g ' '7 W n g @M Q.y g y C @ l N.Y g.g.

3f.-?$f.

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. M.N.My cM MnWh hed but the governor had been assured by the Ni'C that further danger to the publi: sas neg!!gible People :bwly

. stient Co!ct Coding: Blue (Ambutance Cases)

Blue / Black (Ambulance With 1.ife. support Equipment) starten to retura to their homes to l

Green (Tru:h-Litters and Bed Cas:s) resume the normal routine of life.

Ysitow (Sus Cases-Ambulatory and Wheelchair)

Comment Red (Family Taking Patient)

In the midst of all this planning.

certain needs were identified, the Flo 2.-Tianaport statue form foe classificat6on of patient types. county nuresng homes.

Time:

Relocation Hosoitals Date:

I Hospital lM ical/ Surgery Pediatric fntensrve Care Unit ry Care Urut intermediate Mate nity l Neonatal Hospital A Telephone No.

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FQ 3.-Classificahon form for resocetaon hospitale.

• turee Mile laiend-Smem a Fisher Ie5S JAMA. Apnl 24.1031-Vol 245. No.16

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most pressing being that areas sur-decrease possible radiation exposure.

staRiart would be enn more diHieult f

e rounding nuclear power facilities Along with the neds we also to nu.intain. Therefore, we had must recognise the possible extent of encountered problems. The problems requested military medical stad sup-o==*la=* lacident and plan for evaco-we identi6ed rather early dealt with port to keep the facilities open during j

talen of areas both 10 and 20 miles three common areas: communica- & evacuation process, but the l

distant, not just the 5. mile radius tions, transportation, and manpower PEMA chose to deny our request. As previously recommended by the NRC.

resources. Communier,tions and reti. It was, one hospital was on the verge 13 addition, lines of.oonusuaication able leformation were scarce regard-of eveenation because of limited staK

• most be established between local - lag the status of b auclear incident oowrage necessary to maintain quali.

I districts and county and state emer-and b probability of activating our ty medical care. Certainly, better gency management agencies and. plans.. We maintained an extreme-communications regarding the actual l-castbe used both ways to biorm the. readiness posture throughout the en-status at the site would have helped at: sles of the latest news. Coopers-tire seven-day period. Our primary. alleviate the fears that were forcieg l

tion of b agencies along these lines source of laformation beesmo the ' people out of the area.

of communication.raust be fostered network news and not the PEMA,'as.

In response to the neelear incident also to promote a uni 8ed eKort. Fur-established procedures required.

at TMI, the Dauphin County OEP's thermore, a central coordisating There was no constaat now of infor-Medical Command Team has pre-agency must herIdentlAed.to act as as mation to the Dauphia County OEP. pared a plan outlining nuclest inci-11tormation proosener to integrate Many times we had. to call other dent emergency medical pro;;adures.

the needs with the available re-agencies to con 6rm reports we had The plan outline is intended to pro.

heard from b news media. As tb vide county emergency management

sources, Each county must be responsible team. responsible for forrautating and agencies (civil defenre) with a format for delineating its own reception ares, carrying out a massive evacuation,it to develop localised disaster plans for which must not condict with any was essential that we be kept emergency medical reponse to Axed-other county surrounding a nuclear Informed.

facility nuclear incidents and evacua-facility.Thus, evacuation abould.be la The communication problem en-tion of short term /long term care radial directions and not crossing countered during preparation of the medical facilities. While the Dauphin l

[ c.ther lavolwd counties; In other' disaster, response mechanism is at.

County OEP had previausly prepared i

t words, & northern counties go north tributed to the resulting upset in a disaster relocation plan for the

~ and b western counties go west.

the chain of command on arrival of 5-mile radius from TMI, the 5-mile

[

For medical evacuation a system th*e NRC on March 30. Under normal plan did not address medical facility

. must be dedned to categorise and circumstances, the agency in charge evacuation, since the nearest facility elassify patients so that they ars ' would have been the PEMA. But was 8 miles distant.

l transferred to a facility providing when the NRC arrived, authority Within the context of detailing equivalent care. Plans for reduction shifted to & genrnor's oAlee and total short-term ca.re medical facility of patient census must be prepared communication diffleulties resulted.

evacuation, the plan is considered i

also to decrease transportation re-The second problem area wasin the unique. However, the emergency med.

quirements. Patients must be grouped location and guarantee of medical leal plan must be considered as only according to medical classi8 cation transport whicles. The PEMA could one component of the total response an. categorised for available modes not guarantee transportation until an and evacuation plan. A total county l

of transportation. Staging areas at evacuation order was issued. Thus, we nuclear incident disaster plan must i

each hospital must be identiAed for continually sent PEMA our require-encompass identification of exit corri-debarkation such that thero is a mps-ments for transportation, but were dors, trallic control, public notdies-rate staging area for each available never sure whether we would get tion, and public safety agency coordi-mode of transportation.

what we needed when we needed it-nation, as would be Iceluded in ar.y i

Required transportation must be Furthermore, we estimated that it ohr disaster plan.

sathered from outside the incident would take approximately 36 hours4.166667e-4 days <br />0.01 hours <br />5.952381e-5 weeks <br />1.3698e-5 months <br /> to c,; g in, y,a,,, f,gg,,, g,,,,,,,

area so that police, Are, and emergen-accomplish evacuation of all medical N.dissima o=ame = mil.we en reg==s =

th* g,"* ", $ F,e era j

. ey medical services within the af-facilities, not the four to eight hours g

feetad ares eaa respond to local emer-contlaually quoted by the governor's c e Hits, Pa atosi. T. 4. tray sn. e w

gencias that will undoubtedly occur ' office.

Publienties. handlies, and penasa. a contribe.

during the incident duration. Fur-Our third problem area, available 73,$,*",',*,"*/,*Z '"*d* '*@j*,,9*,

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thermore, medical transport vehicles manpower reuources, at times was must be routed along dlSerent high - identiaed as critical. Witirthe extent noteeenees ways so as not to conAiet with civilian of voluntary evacuation approaching evacuation, this being especially ap-40% to 50% of the populace, medical 4,,,

3,,,,,,,,e= istuma.2s4.

plicable tu the critical cara patienta care staffing was critically short. Our

2. ceared tia. Krippes AP. Dimer.c os aine for whom a delay could be fatal.

ialy saving factor was decrea::ing 3,84'"**,'7"'*" "'" 8"" d '*

C"" 8"'

Ideal plans for reorganization and pstient eensus by more than 50% to 3, g,n,,,,, as,. Mediesa dimeiee pJannees*

Ursa u.es. NY / Med un;ttsai4.s. en-redeployment of emergency services keep up with the stas!!ng shortage.

around the perimeter of the evaeus-We were also concerned that should. $,,,,,,,,,,, 4;,,,,,,,,,ig,,,,,,,, y,,, j i

tion area should be developed to an evacuation order come, medical istutza.

l Three Mile island-Semth & Fisher 1659 i

JAMA Aptli 24,1981-Vol 245. No.13 I

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