ML20030B727

Forwards Matls on Hospital Preparedness for Nuclear Facility Emergencies

ML20030B727
Person / Time
Site:	Waterford
Issue date:	04/18/1980
From:	Grimes B NRC OFFICE OF INSPECTION & ENFORCEMENT (IE)
To:	AFFILIATION NOT ASSIGNED
Shared Package
ML20030B726	List: ML20030B725 ML20030B727
References
NUDOCS 8108240047
Download: ML20030B727 (8)

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{{#Wiki_filter:N 4 NUCLEAR REGULATORY COMMISSION fg3v.c g w AsHINGTON. D. C. 20555 .g \\; *.m j April 18, 1980 Per your request here are some materials on hospital preparedness for nuclear facility emergencies, o Sincerely, i i w Brian K. Grimes, Director Emergency Preparedness Task Group Office of Nuclear Reactor Regulation

Enclosures:

1. Hospital Article 2. Monitoring Procedures 3. Bibliography 4 NUREG-0654 s 0108240047y%%2 PDR ADOCK PDR ' H y-l

spEciAL HWUru g HOSPITALMAKES ITSELF CENTER FOR TREATMENT OF RADIATION VICTIMS by Joseph Michael Galvin Jr. 7 ? i ki hat is the role of the commu-the hospital was' asked by a local of the board of trustees, the medi-e W, nity health care facility in utility company to provide medical cal staff, and the utility comp ensuring that proper care is pro-support services for a nuclear pow-along with the Nuc!ent Regulatory vided for radiation victims 7 This er plant in the event of an acci-Commission and Radiation 3Ian-and other questions are provic'ing dent. 3feetingt were. eld with 'the agement Corporation, was formed. y h The committee developed an out-6 a new chaltense to the Nuclear Reg-utility coapany; the Nuclear Reg-line of goals and a timetable to b ulator/ Commission and to Civil ulatory "ommission; and Radiation Defense. These questions also must 3fanag. ment Corporation, a rac.ia-meet them and worked to prepa be carefully weighed by hospital tion accident medical consultant a program for the hospital to cope } chief executive officers, boards of retained by the utility company, to with any potential accident victims.1 trustecs, and medical staffs, for it assist in the devciopment of policies, The' term " radiation ac is imperative that they review and and procedurcs for nuclear reac-defined as "that patient who has e traumatie injury and is contami-j update the policies and procedures fors. that are presently in force at their Our initial project 'was to for-nated with radioactive material." g There are three m:ifor types of own institutions, ascertaining their mulate a group with expertise in radiation exposure that may caus eficctiveness in meeting the needs nuclear power to develop protecol in resolving problems and meeting injury: of the communities they serve. Salem (NJ) County 3Iemorial the needs of the community in the

• Penetrating radiation expcsurep llospital began developing a plan ever.t of an accident. We set as our from a source external to the bodyp of action in 1972-a plan that led immediate pricrity the dcSnition of (gamma rays, neutrons).

to the development of a prototype the term "ac:ident" as.it related to e Internal exposure to radionn-j hospital radiation trauma and treat. radiation. In addition, we cutlined clides by ingestion, by inhalaticu,Q ment center. Despite its rural set-the dimensions of potential health or through a skin break. ( ting, the hospital is in proximity to risks caused by such an accident.

• Skin and super 5cial tissue ex-q major centers of population ?nd in-while looking to tha Nuc! car Reg-posure by centamination of t face of the bcdy with radioactive $

I destry. To accommodate the area's ulatory Commission for further I g rowing need for energy, a net-clarincation of radiation acci-materials. These three types of radiation ex."a work of nuclear. power p!ams is de::ts." being planned and built ap;roxi. We believed that necepting this pesure may occur together. mately 10 miles from the hospital. obligation to provide medical care A patient who has been exposer $. without knowing the dimensions of to excessivo external radiation wili; I'tesently there are two reactors; c'> is operational and one is sched-potential accidents and/or requisite not present a hazard to attendin;m u:..d to be ou line for this summer.. safeguards could icopardize the personne!. Radiation that has inE Tv.o additional reactors are under hen!!h of hospital patients. staff. jured a patient will harm the at. - w.struction with anticipated com. and employees; the total surround-tendant no merc 'than he ing community; am!, more impor-injured a burn patient win harn,.

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the attadant. Equally without haz., l'a r these reason -proximity, tant, the accident victim. ard i s the patient who has receiveth T!.e hospital felt it was impera-( k. ca;* ability, and willingness-tive that we develop adequate'sys-nn overdose of radionuclides by ina eh( tems and facilities to work in har-gestion or inhalation. lie is no mot.f mony with the utility company, the hazarde.us than the patient who ha, .:) oun cor e ',,g car renart suominod a fulfiumor.t ecusultinn firm, and the fer!cral been riven diagnostie radioisotope 3 '..! He:mtd. This ame:c is baseo N [/ ricYCo:ke regulatc.ry ai ency. A profeet com-in the hospital clinie. nuttee. consistin: of representatives llo.vever. the individual whos.- f d W Mmmi trat:r:. 3 ' NII A!.S..t./..HA/f.to/ 1,1073 s

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I t w e ^.-C,., . A -- -. ,...%.N - Q kc..% :n... -.. -,ia .;.1. r. a 1 I- .f.. 2, ~ An important ingredient of the treatment center is a well-trained and proficient treatmant ! cam. Emergency drills are held twice a year at Salem County Memorial Hospital and are videotaped for later evaluation. clothing, skin, or wounds are con-Center concept entrance and a self-contained fa-taminated with radioactive materi-cility that would have capabilities al may present a radiation hazard Through careful deliberation, the to meet all requirements of trest-to attending personnel in the ab-project committee decided that in or-ing a radiation accident, in addi-sence of adequate procedures to der to provide adequate safeguards, tion to meeting any physical in-prennt the spread of the contam-it was necessary to develop a radia. Juries the patient may have incurred inant, or control the radia:!on ex-tion trauma and treatment center in the course of the accident. Ba-posure in the event of a radioactive that would be constructed at the hos-sically, the com is similar to an op-shrapnel wound. If practical, the pital to provide the necessary medi-erating room, with the use of a condition of an injured person who cal support services in the event of a ticluge water s> stem for decontam-is al.so contaminated should be dis-radiation accident. The center would ir.ation purposes. The room is fully cussed on the phone with the nu. become an adjunct facility to the air. conditioned, with a scparate c! car generating station's attending hospital's emergency service com-ventilation system, and includes physician before the person is sent plex, with specifientions for con-water and seware out! cts. The room to the hospital. In all instances, the struction developed by the project posses.ses two water disposal sys-hospital should be given as much committee with the advice of the tems : a portable tank system and warnin:: a.. possible of the impend-Nuclear Regulatory Commission. an underground waste water tank in;c arrival of the patient. Specifications were for an outside for radioactive materials. The proj-HOSPITALS, J.A.H.AJMa's 1,1973 35 a- .e

tion cintaminati:n and the precau;l cet committee, thrcugh public hear-treatment team. As soin as the hos-ings and private negotiations, re-pital is alerted that an accident has tions that should be taken. g ceived public support of the concept. occurred, an alert is put into effect Th2 objectiv:s of decontamisa' During the course of construc-and the team and support person-tion are: tion, the project committee devel-nel immediately respond to receive

1. To prevent injur/ caused by oped a new set of emergency proce-the contaminated patient. Team the presence of radioactive sub' dures and directives for treatment members dress in protective clothing stances on the body.

7 of radiation accidents. The result-and wear dosimeters to monitor

2. To prevent the spread of conj ing procedures manual deta !s a radiation. Maintenance and house-tamination over and into the pa.

8 relatively complex system of emer-keeping personnel have the respon-tient. l gency care involving close team. sibility of preparing the radiation

3. To protect attending person!

work among the utility company, and decontamination arcas as well nel from becoming contaminatet the hospital, and radiation safety as of :ening off that section of the themselves or, in extreme cases specialists. hospital from internal traffic. Phy-from being exposed to a source o: An intricate, triple-tiered system sicians consulting with the nuclear radiation. of medical care ivas developed, power station physicist, attempt to Although decontamination shouh starting at the power plant, which determine the severity of radia-be started as soon as possible, pri serves as the b'ackbone of the oper-ation, with the hospital as the op-erstion's nerve center and a uni. Salem County Mt.noria! Hospital Radiation Trauma and Treatment Center versity hospital as a long term care F.ADIATion TRAu:. A An0 M0mTORmG TREATMENT CENTER and research center. Initial or pre. 1 liminary treatment is administered lll ll Salem C:unty to the radiation victim at the plant t.J f MEMCRU.L HOSoiTAL n 1 satem. :tJ. and the hospital is alerted. Most. of l these injury cases would present SHOWER AREA no hazard to hospital personnel and would be admitted and provided f care in accordance with standard operating procedures. However, an EUFFERICNE ac:ident victim who is radioactive-ty contaminated is admitted, decen-p y MCmT0amG F0m taminated, and treated in accord-S T 0. - -- -- --{--] pV>j-r an:e with specially established pro:edurcs. The purpose of these procedures is to ensure protection of the hospital staff, other patients. RADtATION EM!stCENCY AREA and visitors during admission and y treatment of the radioactively con-5 tamir.ated patient. 5. The hospital's protection pro-cram starts at the nuc! car station n (CONTAM!NATE0 AREA) with an alert or warning telephonc ,LJ call to the hospital informing us 3 0I G that there has been a radiation ac-cident and that one o - more injured and contaminated pmons may re- <;uire treatment. On ;c cipt of sitch i a calt. the hospital staf!' prepares to S

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sgr?ty / { ndmit p.tients th augh the radia. tion trauma and treatment area. STCRACE RCOM g ItAC AT;CM inEATMENT 1 "nEA AMC!AA%CE PEftSCNNEL g l AMUULANCE RECEPi:".*; 10Lc:;C AnEA = IIo-liital ittvolvenient Ar.EA ~' ' mar .\\t the ho<pital, the emergency ' "p:it tment radiation team, conti.st-e,,3,,,,3 3,,,,,,, 7m,,,,gc, a;: M two hospital phymians. a 4 c:en,,ws pe.m., g,, I

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ENTi(ANCE Ib?iid, niake ttp the UUC!Cus of ine [I '% m ts. J.An/ n.:.iy 1,1970 i

SPECIAL REPORT l i i m:.ry attention should be given to twice a year and are videotaped to the facility to devel:p ideas that the alleviation of life-threate:iime ensure thorough evaluati:n. The cunhl be applied in their countrien. conditions created by traumatic in. drills are then critiqued for mem-jury. The utility physicist accom-bers of the team, giving them a bi frm b c panies the patient and is in control better appreciation of their overall of the decentamination process. roles and of any problems observed in the shadow of the Three Mile If the patient is severely injured, during the course of the drill. This fsfand nuclear power plant incident, immediate life. support car.: is ad-procedure has become a recom-there undoubtedly will be a review ministered to stabilize the patient's mended standard of the Nuclear of the design and safety of nuc! car i vital signs before the patient is Regulatory Commission for those power plants in the United States. flown by helicopter to the primary institutions providing such a ser-A constructive npproach to the treatment center at a nearby uni-vice. The films are used as a source evaluation of the incident will pro-versity hospital that is equipped of in-house training for both the duce new safeguards and enab!c { with more sophisticated and pre-medical staff and hospital person-not only the utility industry but cise instrumentation and support nel. In addition, a team from Radi-also hospitals to make careful eval- 'y systems, not only for radiation ex-ation Management Corporation pe-untion.S of their policies and proce-posure but also for any other med-riodically surveys the facility to dures in hand!!ng radiation acci-Ical needs that may be involved. determine if the sophisticated mon-dents, along with their policies and Safety procedures after the radi-itoring equipment and medical de-procedures for mass evacuations l ation patient has been released are contamination supplies are in or-should the need arise. A construc-j considered as important as those der. This team is also responsible tive approach will be needed to im-l during the emergency itself. All for evaluating and critiquing the prove these policies and procedures. clothing of the patient and the med-emergency drills that are held Perhaps it is time for the Joint ical team must be disposed of, and twice a year. " Commission on Accreditation of f the facilities must be thoroughly The results of this cooperation Hospitals to develop standards for washed down by radiation special-among the hospital, the utility the care and treatment of radia-f ists. Finally, the radiation emer-company, the nuc! car power plant, tion accidents. gency unit's separate sewage sys-and the Nuclear Regulatory Com-The future of our nation will de-i tem must be thoroughly drained by mission have been gratifying. Ex-pend largely upon development of j the specialists. Disciplined coordi-plicit policies and procedures have our full energy capabilitics, in-nation is imperative to successful been developed and implemented cluding nuclear power. Currently, l completion of the safety procedures. within the hospital, preparing our nuclear energy provides roughir i Chief executive omeers must be institution in the event that we are onc. eighth of all electric power gen-j willing to become more familiar called upon to treat a radiation ac-erated in this country, and there, I an,! acquire a better understanding cident. Assurance is given to em-are more than 70 nuclear power j and appreciation for the care and playees an ' residents of the reactor plants in 27 states with operating I tientment of victims of radiation area that their medical needs will licenses.- Our scientists have cer-I i accidents. It is the responsibility of he met in the event of a radiation tainly amassed tremendous infor-l the chief executive omcar to become accident. The hospital's image is mation from the Three Mile Island I the key contributor to formulating not only safeguarded but also up-experience and will be able to ap- } and executing the policies and pro-graded. Its radiation trauma and ply it as they continue their at-l eedures to provide adequate sup-treatment facilities have given it tempts to perfect nuclear energy f part facilities and care should the added prestige. The nuc! car power production and to develop stringent need arise. plant received regulatory approval safety requirements. and is now in operation. In the meantime, hospital chief - The approach taken by the hos- _ executive omeets in proximity to .l' raining rer[utretj pital, utility, consulting specialists, nue! car power plantihte a respen-It also is the responsibility of and federal government stands as sibility to assure the communities the chief executive of".cer to pro-a landmark for cooperation among they serve that the best,possible fa-vide tha medical start and other the private and the publie sectors. cilities aml trained personnel will hospital staff with training courses The emergency pracedures drawn be avajlabjelho.Md TrEdistion ac-~ and emergency drills to better pre. up for the treatment of radiation-cident occur. m rare them for an emergency. Con-contaminated patients sene as a j stant evaluation of drills and up-mndel for the country. The hospi- ] datin: of policies and procedures is ' tal's radiation trauma and treat- { important to ensure the success of ment center s"rves as a prototype future responses to an emergency. for desi=n of such facilities at hos-3 i At Salem County >!cmorial lins-pitals throughnut the country. Also, pit d, cmergency dri!!s are hcid several foreign guests have toured 40 llOSPITAl.S. J.A.itA./May 1,1079

, '4 ~Wft3W'IMLiliVf=bR f! / !!Of4110Rl!4G POTEtifiAll,Y H AD10 ACTIVELY C0tiTAMINATED with palms up, then repeat with hands and arcs It;DIVIDUALS turned over. e. Starting at the top of the head, cover the

1. Locate an area free of radioactive contamin-ation and with low background.

antire front of the body, monitoring carefulig the head, neckline, trunk, legs, crotch and armpits.

2. Use a C-H type survey meter such as the CDV-700 (Civil Defense Type). Attach headphones because f.

llave the individual turn around, and repeat this allows the monitor to visually follow the monitoring on the back side of the body. and better control the position of the detector probe while monitnring. The head-g. !!onitor the shoes and soles. phones also respond more quickly to changes in radiation levels than the meter. 6 /. -d 1

3. Check the operation of t;ie survey meter accord-ing to instructions provided with meter.

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4. Place the survey meter in a transparent plastic l')

[ bag to prevent contamination, leaving only the probe exposed. For maximum sensitivity, the a j{ \\ p,N *. I I open (exposed) window of the detector probe \\ should be used. The window is a rotatable [j g y I cylinder on the probe which exposes or covers N[ 4,, Q l. the detector tube. /

5. Note background reading of meter.

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6. Monitor the individual as follows:

7., Again note background re ding of meter.

a. llave the individual being monitored stand on a newspaper. This wilI reduce the possi-

8. Use carphones to find areas of potential bility of contaminating the monitoring site.

contamination. Change the newspaper frequently.

9. Radiation readings that are twice background' indicate that the person may be contaminated.

b. Place the survey meter probe about 1" from the Individuals should be decontaminated. tioni-person a body, being careful not to touch the person.

tor individuals after decontamination to determine that contamination has been

c. Instruct the person to stand straight, feet effectively removed. Repeat decontamination spread slightly, arms extended with palms up

,rocedures if required. y and fingers straight out. NOTE: If the background readings taken before and i after monitoring the individual are significantly different the person should be remonitored. i I

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DEC0tiTAMIllAT10N OF VEllICLES AND EQUIPi!E!4T PERS0!1tiEL DEC0t1TAHIllATIOil

1. Upon completion of missions in a con-4

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1. Remove clothing and place in a plastic bag.

11atk radioactive do not discard. used by personnel should be monitored, I*

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2. If possible take nasal swab with a cotton plete decontamination may not be swab, identify, and save.

Do not delay necessary, but attempts should be made reduce the hazard to tolerable levels. showering if swabs are not at hand. to

3. Shower thoroughly with water and a liberal

2. A decc,ntamination station set up at a

amount of :,oap applied. Specific in-contrul point adjacent to the staging area would be the best place for de-s tructions are: contaminating vehicles and equipment. Skin - Use a sof t bristle brush vigorously but A paved area would be desirable so that lightly so as not to abrade the skin. Partic-it cculd be hosed off after the equip-snent p decontaminated. Monitoring ular attention should be paid to cleaning around and under finger nails, between the fingers and should follow the application of each the back of the fingers on the palms, when the duontatution method. at hands are contaminated.

3. The simplest and most obvious method llair - Scrub the hair vigorously using a liberal for partial decontamination of vehicles amount of soap. Particular care should be taken and equipment is by water hosing.

te prevent suds and water from entering the eyes, ca rs, nose or mou th. Several washes and rinses

4. Hosing should not be used on upholstery shoule be applied before drying the hair.

or other porous surfaces on the interior s the water w wld penetrate ve s,

4. Monitor individuals after decontamination to nd carcy the contamination deeper into the determine that contamination has.bcen ef f ective-material. The interior of vehicles can be ly reinoved. Repest decontamination procedures decontaminated by brushing or vacuum clean-if required.

ing. seek advice

5. Special precautions should be used when

5. If person still show contamination, of supervisory personnel

• vehicles and equipment are brought in for maintenance. The malfunctioning part of the vehicle or equipment should be checked for excessive contamination.

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L 5 ; blo rs. RadiationAccidents-Mdicslpspects Medical Aspects of Radiation Accidents. A liandbook for Physicians, 1. Health Physicists and Industrial flygienists; Saenger, E.L.(editor). USAEC,1963. x 2. Diagnosis and Treatment of Acute Radiation Injury; World Health Organization, Geneva,1961. 3. llandling the Radiation. Accident Victim, A Guide for Hospital Personnel; Colorado Dept. of llealth (Anthony Robbins, M.D., Executive Director, 4210 East lith Ave., Denver, Colorado 80220). 4. Emergency Health Services Health Mobilization Series, A-6, DllEU/PHS,1967. 5. Lincoln, T.A. Importance of Initial Management of Persons Internally Contaminated with Radionuclides. Amer. Ind. Hyg. Assoc.J. Pg.16-21, January 1976. 6. Planning a Medical Unit for Handling Contaminated Persons Following ' - a Radiation Accident; Holland, R.U.; Nuclear Safety 10(1):1-13, Ja n-Feb'. 1969. 7. Hospital Planning to Combat. Radioactive Contamination; Saenger, E.L., JAIM 185:578-581, Aug.17,1963. 8. Radiation Accidents; Saenger, E.L., A. Journal' of Roentgenology, Radiud Therapy and !!uclear Medicine, Vol. LXXXIV, No. 4, Oct.1960, Pages 715-723. 9. Seminars on Medical Planning and Care in Radiation Accidents; Nuclear ..~: Safety,9(6): 521 (Nov-Dec.1968).

10. The Diagnosis and Management of Accidental Radiation Injury; Thoma., G E.,

Ual d, H., J. Occ"p. Med., 1:421-447 (1959). i 11/. Planning for Care of Injured Radiating Patients; Horw< o'd, U.D., M. D., USAEC Report HU-SA-2859, Hanford Atomic Products Operation. December 29, 1952. 12. The Hanford Radiosurgery Facility; Unruh, C.M., Larson, H.V., and Fuqua, P. A. June 1969. Available from Hanford Environmental ~, Health Foundatica, P.O. Box 100, Richland, Hash. 99352. 13. Facilitics and Medical Care for On-Site Nuclear Power Plant Radiological Emergencies; AtlSI N-682 or Amer. Muc. Soc. Standard 3.7.1; should be issues late in 1977. A -.}}