ML20008D477
| ML20008D477 | |
| Person / Time | |
|---|---|
| Site: | Seabrook  |
| Issue date: | 05/31/1989 |
| From: | NEW HAMPSHIRE, STATE OF |
| To: | |
| References | |
| OL-I-MAG-108, NUDOCS 9003050176 | |
| Download: ML20008D477 (21) | |
Text
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- ATTACHMENT A
- .(New Hampshire Radiological Health Program Modul'a 23A.
- t Hospital' Management Of Contaminated and Injured Patients)
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- dri t t e n B'/ : Procecure No..
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i NEW EAXPSHIRE EADIOLCGICAL llEALTH PROGRAM i 1
MODULE 23A I .
- HOSPITAL MANAGEMENT OF CONTAMINATED'AND INJURED PATIENTS !
i SEABROOK STATION V
PEBRUARY.1988 .!
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TRAINING REQU1REXEh73 Xey hospital personnel will require the following training:
Training Module I;A - Hospital Manage.t.ent of Contaminated and Injurec Patients
'Jpon cospletion of the acove mocule hospital personnel will partic!; ate-'in an annual refresher _wnich will consist of a review of procecures including any changes r.ade since the last exercise.
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Attacnment A'(Page 3 of 20) t COURSE SCOPE AND CBJECT:YES L SCOPE ,
- his'tra:ning ecoule provides instru: tion for key hospital personnel in the !
anaget.ent Of tr:uma enc ra:10 active contamination. 7: pics include cecical- '
priorities, contaminat2:n centr:1 personal protection and survey tecnniques. .
The Emergency Classif!:stica Levels (ECL) will also be taught.
.09]ECT'YIS '
4 At the c:nclusion of this program, theparticipantshould[bea:letedothe fellcwing:
i Exclain the cifference between exposure and contamination with regard to '
rac:ati:n anc racicactive'enterials.
.'nd e r s t a n wny basic !!!e support r.easure have priority over centamination
- entrol reasures.
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- 3. ?.ecite to basic equipment neeced for personal protection from radioactive contamination.
- 4. Emergency Department personnel should be able to act on vital inferr.ation from Ambulance _ Personnel with regarc to patient status and degree of-contamination.,
- 5. Emergency Departments _snould understand basic principles of contamination 1
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contr:1 for personnel and environment and be able to explain the rationale '
for sample taking anc labeling.
- 6. Turn on survey meters. check batteries. check background and do a survey for contamination. "
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- 7. Explain thel Emergency Classification Levels (ECL) system.
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V5i in GENERAL COURSE INFORMATICN LV
,' , (CCURSE **-*E: -Hospital-Management of Ccntaminated and Injurec
, r i, AUDIENCE: Hospital Personiel'
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ic . B, i T DURATTCN:- 1.5 Hours 4 SCOPE: This training module: provides instruction for key hospital E personnel In'the management'of trauma and-Ladioactive con-tamination. *opics include' medical' priorities. contamination- '
c:Ltrol, personal protectica and survey techniques. The Ezergency Classification Levels (ECL) system will also be taught..
~Empnasts in eacn section will vary depencing on staff background eno role in facilit7 RERP, v>TEF ! A'.5 : -Screen
, Slides Projector and Spare Sulb-Videotape
'C" VCR and Monitor Screen u Survey' Meter
, Dosiastry Kit-
! Attendance Form Participant Handouts-4 EEFERENCES: =: . NUREG C654/ FEMA -REP-1. Rev. 1
- 2. Title 10. Code of Federal Regulations. Part 50.47(b)(12)
- 3. FEMA Guidance Memorandua MS-1 4.. Joint Committee hn the Accreditation .of' Hospitals.
i Emergency Services ERS.1.2.20 1387
- 5. ' NCRP Report No. 65. Manageme$t of Persons- Contaminated with 7 Radionuclides f 3
- 6. Department of Health and Human Services. Food and Drug Administration 83-8211. Preparedness and Response in '
Radiation Accidents. August 1983 ,
- 7. Medical Health Physics. Fourteenth Mid-Year Topical
,g Synposium. 1980
- 8. Hafen and Karren. Prehospital Emergency Care and Crisis Intervention 1983 t
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Attacim3nt A:(Pago 5lcf 20)
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COURSE C'JTLINE- '
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i Management cf ' contaminated and Injured Pat:ents - Hospital Persennel.
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. Sectien cetes ,
T!me __
I, Introducti:n '
2 min.
II. -?asic Concepts and Definitions '
15 min.
1111. Concepts of Exposure and Contamination *
, 10 min.
- V, 4
' Radiation Detection anc Instrumentation 5 min.
., Protecti'.*e CIct.ilng 2.=in.
~V I ,
Priorities ine Trauma Management and !
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Contamination C:ntrol t min. ~
VII. Preparing an Ambulance for Accepting a Contamina'ted Injured Patient =2 min. i d
o, R. VIII.
- *f, Trauma Management. Decentamination &
Sample Taking 15 min. ] '
IX. Management of Severe Exposures 5 min.- I a
X. Emergency ClassificationLLevels 5 min. l XI. Video Tape - Hospital. Emergency . = i.
!' 25 min.
. Department Resnonse to= Radiation Accidents 'j i
.1 X I I '. - . Summary !
-10 min.
XIII. Questions and Course Evaluation
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4 lNSTRUCTORS GUIDE !
$odule'Numoer: 23A h urse Fitle
.u.ospital Management of Contaminated and-Injured Patien
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1.ecture ~A Time _,
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- . Introduction
, 2 min. 1 A. Title Silde #
' Thenow you purpose t: of this program is to instruct
- stients. manage contaminated and injureo Regulations ~
The progra:
the stancarcs of: la designeo to seet .l
'1.
-2. NUREG-C654/ FEMA-REP-1 Planning Standard:
- 3. 10CFR$0.4" (b)(121:
- 4. FEMA Guidance MemorandumandMS-1:
JCAM Standacts for Emergency Services ER.5.1.2.20 B.
'Tha three main areas of concern we will be
. talking about. include mant.gement of the patient, Priorities tion -of the environment. protection of the staff, and protec- >
- 1. s
. -Physics fasic Cefinitions and Terss in Radiological
- 15 min.
We need' to discuss some -basic teras and defini-tions to clearly identify ~what radiation and Radiation
' radioactive-materialsareanghowtheybehave.
_.4 A.
The electromagnetic spectrum includes all
. radiation which is without mass or particulate EX Spectrum nature?and moves at th6 speed of Pight. 'This
,i-(; includes electric power at the lom end through radio waves:-visible.. light: infra d and
)j ultraviolet, to ionizing x-rays g@amm:a rays.
and end. cosmic rays from outer space at the high The energy of the rays at the upper end
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2 Attacruc3nt A (Page 7 of 20) !
I Lecture T!me g of the scale (r:s x-rays to cosmic rays is high enough to cause~1onization of atoms.
causang disruction of chemical bonds which results in ca: age.
- 5. "or our purposes, we will be talking about radiation that comes from atoms which are Atomic Structure L
radioactive. This picture of an atom is not radioactive: we call it stable because it does.
not give off any excess energy. The parts of .
i an ates include a very cense nucleus of .
neutrons anc protons. Neutrons have no charge i
and protons have a positive charge of +1.
llectrons, wnien have a negative charge of -1 anc normally balance off the positive charge j o.
of the nucleus troit arounc the nucleus. The j
electrons have a :sss only about 1/1800 of a i
nucleon so they do not t:ke up much space in their orbits around the nucleus.
C. A radioactive atos has a surplus or deft- '
ciency of'one of the nucleons and this Radioactive A. tor results in an unstable configuration.. This l
' leads to a nusoer of different ways the atoa ,
can transform to become stable and thereby release energy in the form of radiation.
There are many t'ipes of radiation that'can be i
emitted and more than one type can be esitted from the same atos.
l 3. Let us look at the types of radiation we will 0 Alpha Radiation.
be concerned with in the most likely types of 'y radiological energencies. ,
, 1. Alpha radiation is 2 protons and 2 neutrons with a +2 charge. It is actually a Hellus atos stripped of its electrons. i L Comparatively speaking. In the Itomic world it is very large and heavy and does
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not go very'far even in air. Il carries a lot of enerry and can do a lot of internal damage to live tissue: it will not, however, penetrate the dead skin layer outside of our bodies.
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- iy Attachn3nt A-(Pago 1).of 20)i "
Lecture Time gligg.
2.
Beta rsointion'is an electron with a Beta Radjation negative charge called a beta particle or a positive charge called a posstron. i it can be emitted directly f rom the ,
nucleus or possibly from under the certain croits. c:nditions.
It can travel '
a f ew feet in air ano penetrate the skin ,
but is depencent upon the amount of energy available. ,
- 3. Gamma raalation is the high energy
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electremagnetic r ctation we- spoke of ,
Gamma Radiation earlier.
It- is emitted fica the nucleus and semetimes ace::: antes alpha and beta raciations. :t is more cangerous than I the otner types because it is so -
penetrating.- Reme cer, atcas are mostly empty space and gan=a radiation has no
- ass cr charge so it travels a long'way before it interacts. Gamma radiation is a threat _both internally and externally. '
1 X-rays are physically exactly like gamma X-Rays i
rays except that they are usually of l owe r - energy. The energy spect,r as overlap. The difference in physics'is 'q where 'they originatet ganea rays originate in the nucleus anc x-rays. originate in the oroital snells of- the electrons.
- 1. The ters used to descr:be how many radioac-Curie 1 tive atoms we have is called a curie. This tells us how many radioactive atosa are disin- .,
41 tegrating each second or ,ainute. or how many unstable atosa are releasing radiation and .
goingLto a stable state.
2 P. A Soentgen tells us how much radiation is Roentgen passing through a given volume or space of l
air, we are actually sensuring honimuch lonization is being produced. Thir can:be 1 e
measured-with a survey meter, j
-G.
A Rad (Radiation Absorbed Dose) is how much Rad energy is being absorted in a given medium.
As the radiation bumps into selecules. it c,
causes .lonizations ~ and dissipates its energy along a path through the material.
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Lecture ,
Time g {
M. A Rea relates the amount cf energy in Rads Rem !
teing depostteo in living tissue by multiplying a cuality f actor times the Rads. 4 This CF etuates the biological damage to {
200-300 kev x rays which can te easily tessured, contiolled. :nd reproduced. !
111. :encepts of Exposure and Contamination 10 e,in. '
A. Exposure and centaminatten are two ir.Mrtant 5
terms that are used often and easily confuseo ,' Fire Illustra-so we will r. axe a comparAson to fire for tiens :
staplicity. :gnore the tr. ext component. If you sit near a fire, you aosore radiant ,
heat which can te controlled by distance.
You also can centrol it by using a barrier i for shielding the heat. This is called expo- l sure and in analagous to raciation tranciples of acre energetic radiation. If you step -
arto.the fire and an emoer sticks to your shoe, you have been contaminated and '
obviously your exposure to heat is being dra- '
aatically increased as well. You also can be i contaminated by having the wind blow embers "
or hot ashes on you. .
(Note There are several other c aparisons '
that can be mace if warrantaa.) ,
$. Exposure centrol in amanned hv three " g-einles alreany r.mntiened. Exposure Control, The total amount Time Distance of time you spend in a radiation area or with Shielding a radioactive patient should be short. Only
' a few feet between you and a source make a :
dramatic differ *' ice in th's exposure rate.
shielding with vehicles. concrete, or lead is ,
- only practical when you have a very intense
' but stationery source of radiation.s For
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transferable radioactiva contaatnation. ,
coveralls and/or your clothing is agleguate
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i protection wnen used in conjunction # with other protection principles.
C. Contamination control is achieved by assuming that everything that touches a contaminated Decontamination Teams Suiting Up objnct will become contaminated, Tha t i s ,
you wear protective clothing or protective 13 - N/M0023A-4 n - - - ~ ~ __ . . _ _ . a
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3 AttactCOttt A (Pago 10 of 20) ;
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Time _ g [
t coveralls with the intent of it potentially teing contaminated ano then ciscarcing it 1 Into receptacles before leaving a restrictec l area. )
(Note: New that we have covered the basics, are there any questicns before we continue?)
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Radiation tetecticn and Instrumentatten 5 man. .
A.
' 1.ct us move on to radiation detection to
- Survey Meter i
examine how a survey teter works knen it .
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" sees' radiatien. As radiation passes througn air er any other taterial. It causes 1:n12ations cy cuscing into ateas, a gggey Probe Diagras probe works tv cellectine the eierte nn ero-dEcon frem ten emirm. If you look at the .
diagram, the w1re in the middle of the proot has a positive enarge of about 700-900 volts which strongly attract the negative ;
electrons. Each gamma ray that penetrates the probe volume will send a cascade of electrons to the probe wire which causes a E small surge cf electrical current in the meter circuits. The flow of current is pro- ,
portional tu 4'e amount of radiation passing througn the yrice. i (Note: Demonstrate with survey meter.) '
B. Operation of a survey meter is staple. First
-you check the batteries. survey Meter Face If your seter does not respone. check to make sure they have i been installed. Next ehmek baenneenund! thmen l should be a few counts per minuta audihla a r- '
about 0.02 mR/hr ra' -M"-d M -b-*aii-d _ Do this in a neutral area away from suspected !
sources. Some meters will have a chgek source usually mounted on the side of. the meter case. There should be a significant
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rise in cpa when the probe is placetr against the source.
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I Lecture ;
- !$e Slide f
Frisk Diagras
- . A frisr. survey is done as in this diagrus ano i j
snould take aoout 3 .inutes. Double check patient Disgram )
suspect areas ano have a recorcer put the cpm l
' en a ratient diagram or a Met Tag, v e t Tag
- 1. Cr,ver the probe with a plastic bag j
- 2. Tarn off the aucin l
- 3. Ca not confuse internal with external )
raciataen I
Dosimeters and While surun. *erern are rate seters.e"---+=
dosina.- .
I D. . Chargers l ters are total cellected dose ian I tTat snew cese accur.ula_ted in mill 1Paa. There i
are three types with which you snould be f ami- ,
'!ar. Pocket desir.eters are self-reacing !
loc 12ation enameers that are cnargeo just before ]
use enc disenarge at a rate proportional to the 1 ractation passing througn them. ILDs are l I therr.oluminescent desiasters. These are small thips wnich absore the energy of radiation as ,
it passes througn anc release it as light when 1 heated in a specially designed reading instru- f sent. The last type, which may be available !
and widely used in hospital radiology depart- I zents, is the film bacte. Radiation exposes l fila and the degree of film blacknees is pro-portional to the dose.
2 min.
Protective Clothing for Contaminaticn Control 1 Decontamination Protect 2Ve clothing is worn to prevent con-Technicians tamination f rom coming into contact with the skin suiting Up )
or being inhaled. At a miniana. field personnel i should have disposable gloves. masks. and booties, ,
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It any not be practical to p.ut on surgical coveralls or Tyveks as will be done in an Energency Department. The decision should be made on practical considerations and time constraints. l
.r L 5 min.
y!, Priorities in Management of Trauma and ;.
Racicactive Contamination 2 Medical Priori-A. First responders who will be transporting ties Contamina-patients need to be familiar with contamina- tion Control )
tion control procedures and manage the medi-
! cal problems as well.
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AttCchmOnt A (Paga 1; og :o)
Lecture \
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Rememoer!!! i priority.
The teolcal ;t: Diem is the first ,
The contamination is a seconcary !
con 1cerati:n. hsnoled af ter the patient hat ;
teen stab 111:et.
3.
When you get a call involving raoicactive ;
materials have your cispatcher get as tuct.
inferr.ation as petsible frca personnel at the t scent hospital andaspass well.the infer:atica along to the ,
Try to get hold of screene l to respona with a survey e.eter if possible, However, a survey r.eter it not absolute'y necessary t:
d l manage the patient.
'/ : 1. :
Tre:aring the A,tCulance/Hosoltal I0r Accepti ng a 2 0ja,
- ntar.inatec Ir.1 rea Patient i A. While enroute t0 !
the scene. Ett the amoulance preparea by laying floor c vers anc getting a out c:veralls ano gloves. etc.
B.
On arrival. ;roceed to the patient while asking as r.any questions as possible of EMTs "Packagint fellow worxers er bystancers. Patient ,
- 1. Treat-the injuries first. 1 2.
Cnce stabill:ed perform slaple decon-taatnatten if possible: 1.e.,
clothing (quick ano easy). renoval of 3.
Transfer to backboaro and wrap for transport. A plastic sheet or plain linen will be sufficient. Plastic say ,
not be patients.
obese a good idea in wars weather or f or ,
4.
Monitor the patient's' vital signs as ,
usual. i 5.
A face mask will prevent the patient froa Internalizing any contaatnatiop as long
- 6. as it does not interfere with breathing. l Inform the Emergency Departmens ASAP of the follcwing # Hospital Infor-mation
- a. Number of patients
- b. Trauma status
- c. Exposure / contamination c . 3, N/M0023A-7 n .
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. AttachmOnt A (Pago 13 of 20)
Lecture TI*' -
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- d. Type of : dioactive attrial
- 1. Isotcpe/ quantity
- 2. Physical s'. ate
- e. Esti: ate time of arrival 7.
Check cn amoulance entrance it different from usual. Upon arrival, till in details F
and stancby for decentastnation if .
necessary. ,
C. 'The hospital needs this information to make a Hospital ED decision on whether to set up the decen area and ecoill:e a full team in coveralla or just stancby with a nurse ano a wasn cloth. After notificata:n. t.'.e physician in charge will have to maxe a cecision.
D. It any take up to 20 minutes to prep the receiving area and mobilize key personnel on Floor covers the Decon Teast longer if during night shif ts being taped down and people have to be called in. The key steps to be taken include the following.
- 1. Traffic control barriers and signe
- 2. Floor covers laid
- 3. KVAC systems shut down
- 4. Equipment mobill:ed to decon area
- 5. People socall:ed ano suited up vi!I. Trauma Management. Oecontamination. and Sample Taking 5 min.
A. As patients arrive at the/ designated i entrance, they should be slaultaneously Decontamination in progrees assessed for vital signs and surveyen for contamination.
2 B. Manage trauma first.
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C. Once the patient is stabilized then more attention can be given to a thorough survey and decontamination as necessary, 1.
Monitors should record initial _rtadians on* patient dianen== and finni e==de---
wnen cecon is enanlate ta me..nemhi.'~ -
levels.
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- 2. First ;revent external c:ntamination fr:m ?
being internal 12ec. Prevent local con-taminata:n it:m being generali:ed.
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- 3. L'se water s;tringly to prevent splashing.
- 4. Wipe with damp cloths once and save at j sample. Se sure to label everythingill When suf ficient samples have been taken, l i
dispose wages in p.icper trash recep- ,
tacles. Wiping more than one area with a i
. 1 cloth ray spread contamination rather -
than containing it. l
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- 5. Samples snould be carefully baggeo and l i
labeleo ano sucatttee f or analysts. !
Which s;ect: ens will be held f:r in-house !
analysts anc which ones will be sent cut to reference labs should be worked out in advance. !!aint of blood samples for CBCa are critical f or wnole-body dose assessment and the likely course of patient oute:me. !
l D. Moniterm should be reeneckle ==--- aa natient fEef f ectivenene of decentaminatien sensures.
Also ennatant Checkt da"Id M rift M etaff l' a.no equiesent fer centeni ef anv transferracle c_entas t na ti en - -'
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!. . At some point. trash receptacles any and to increased background and cause aisleading sur- I voy readings. Trash should 'be removed if this becomes a probles.
.. i F. When the patient is medic' ally stable and all !
external contamination is removed to acces-table levels, the patient can be transferred to a room for further monitoring, iedical condition still has priority. :
k' G. Consultants should be brought in to assist in l strategy for patient observation. total dose assessment. decorporation of any internalized t
radionuclides, analysis of sampless and coa-sideration for transfer to another facility i
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with greater capabilities.
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l Lecture l
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IX. Management of Severe Exposures 2 min. f l
A. :! a severe exposure is suspected, several Eevere Exposure measures must te taken to assess and monitor Clinical Chart {
the patient's progress. Clinically the I patient may have nausea, vomitir.g and diarrhea. Psychological support will te -
needed early on as the patient will realize how grave the situation may becose.
l B. Acute locall:ed exposures need to be watched i for loss of function. pain, tinglir.g. and '
tissue perfusion and viability just as in thermal burns. i
- . Severe whole-cooy exposures snould be trans- i ferreo to a facility with isolation units for l infection control and e. arrow transplant capa-bilities to head off crises in the next 30 ,
days. 5i
- 1. Before transfer, baselinre blood work should be drawn and a schedule set I up for recrawn. Iarly blood counts will i
be the most important indicators in pre-dicting the patient prognosis.
- 2. Patient dosimeters should be sent for ,
processing if available, i
- 3. A professional physicist should be called in to help reconstruct the accident and >
further quantify actual exposures.
. i D. All samples collected until time of transfer *i should be adequately labeled and any results
- forwarded with the patient or as soon as possible thereafter, s
. E. Allthisisbeingdonetoprovideb$seline information to help manage the tapeiding crisis of bleeding disorders associated with pletalet deficiencies. Infections associated with leukopenia, marrow suppression, and ;
pancytopenia, ,
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Lecture F. :t .'.s important to note that the 11te- A threatening effects of severe exposure may cume weens after the incident ano that efforts snould first to put into trauma sta-bilization if incicated. ! a transfusion is ecessary for blood loss, do not use a rela-tive. Their art:w may be required for a g transplant later en. Use of their blood would sensiti:e the recipient to the donors blood compenents and ensure rejection of a marrew implant at a later time.
X. Ir.ergency Classificatien Levels 5 min. ICL A. Unusual Event
- 3. Alert
. Site Area Emergency O. eneral Emergency X. . '!!deo Ta;e: Hospital Eemrgency Department 25 min.
Response to Radiatien Accidents XII. Summary of Group Responsibilities (Note: :nstructor should review the respon- '
g.. . .
sibilities of the specific audience.) '
A. Group 1 - First Responder First Responder Responsibilities
- 1. Ambulance Preparation L a. Floor covers l b. Disposaole clothing
- c. Survey meters
- 2. Patient Stabilizatiett !
a.
- a. BLS first l' +
- b. Decontamination second '
- 3. Patient Packaging ,
. a. Backboard j
- b. Wrap for contamination contril i
- 4. Hospital Notification 1
- a. . Medical status l b. Radiation information l
- 5. Transportation l l
- a. Monitor patient l
)
- b. Alternate tabu 1&nce entrance l-u o -1L agt - . _53fi28000-M__--- .
6 Attachment A (Page 17 of 20) i Lecture
?!me g A. Environmental Services 10 min. ES Respons1 bilities 1.
9 Access Control
, a. Security
- b. Internal / parking e
- c. Barriers
- d. S!rns
- c. Verbal directions .
- 2. Decentamination Area Setup
- a. Maintenance / housekeeping
- b. Flcor ccvers
- c. Isolate environmental air systeos in Decentananation Area
- d. Mobill:e equip:ent
- 3. Contamination Control
a.- Barrels
- b. Plastic liners
- c. Tats / labels
- d. Dispgstoles supply
- 4. Dispostoles Supply
- a. Tcwels
- b. Coveralls
- c. T7vens
- d. Giovaarbooties/sasks
- 5. Waste Disposal
- a. Drus handling !
- b. Labeling
- c. Contact Seabrook Station '
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2 a
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. Attacre:ent A (Page 13 of 20) -l i
Lecture }
T!se sg I
B. Technical Pers:nnel 10 min. Technical , J
- 1. Mobill:e Ecultment
- a. Survey r.eters
- b. Cecontaminatten carts 1
- 2. Provide Monit ring '
- a. , Patient surveys
- b. Envarenmental surveys
- c. Direct cecontaminatica efforts
- 3. Control C:nta=1 nation i
- a. Restr:cttc areas
- b. Moniter staff
- c. Proper disposal '
- 4. Assist Sample Taking
- a. Blood draws
- b. Contamination wipes
- c. Saaple containers .
- d. Labeljng
- 5. Process Sample Analysis
- a. Inhouse analysis *
- b. Reference laboratory encout
- c. Prepare samples / reports for transfer ,
- d. Assist in sample strategy C. Professional Personnel j 10 min. Professional Responsibilities
- 1. Incident Assessment *
- a. Physician / health physicist e
- b. Scope / resources required , -
- 2. Mobilize Hospital
- a. Announce alert code
- b. Call in key personnel
- c. Set up decontamination area
- d. Cather information from scene
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t Attachm^nt A (Pago 19 of 20)
, i Lecture '
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- 3. Direct Respense Teams 1
- a. Brief teams en details
- b. Help suit up/ issue desimetry
- 4. Evaluate and Manage Trauma
- a. F.edical' priorities
- b. Contamination secondary l p 5. Perform Decentamination i 1
- a. Direct personnel in techniques i
- b. Cetermine acceptable limits l i
- 6. Campling Stratery 1
1
- a. Order c!ced samples l
- b. Cverset wipes for analysis d J
- 7. Patient follcwup '
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I 1
- a. Long-tern sonitoring
! b. Referral l c. Accident reconstruct:en !
S. Consultation Requests ,
- a. Exposure worxups/ mart w transplants I t.
- b. Health physics /desimetry D. Management 10 min. Management
- 1. Plan Development Responsibilities ~
i
\
- a. in print and availa*ble
- b. Updated periodically
, c. Key people on review committee '
- 2. Regulatory Ccapliance ,.
i a.
Meets JCAN ER-5.20
- b. NRC C654/FEXA-REP-1 Planing Standard L
- c. FEMA MS-1
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L~e, Attachm3nt A (Pago 2D ef 20) -
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Lecture II*' -
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Community Coorcinatten 2, i
- I
- a. .ccal gcVerne.ent agenciee
- t. Ambulance ccmpanies/ EMS k
- c. Industry '
- d. Fire services
- e. Rescue services i
- 4. Training Pregrams
- 8. Meet criteria of regulattens -
i
- b. Periodically offereo
- c. Qualified instructors
[
!. Ort 11s/Criti;ues
- a. Meet Criteria
- b. Test systems acequately (3 shifts)
- c. Critique fer improvement -
- d. Deficiencies corrected
- 6. Systems Maintenance r
- a. Decontamination area properly designed
(
- b. KVAC systems isolated
- c. Equipment available
- d. Survey meter operatien/ calibrated
- e. Disposables stockpiled i
. Plan Implementation . *
- a. Hospital alerting capability
- b. Mobilization procedures (3 shifts)
- c. Call lists staff /cenaultants/
emergency services
- d. Patient classification / flow chart ,
XIII. Questiona and Course Evaluation #
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OD13A-25 a . - -