ML20092J913

Applicant Exhibit A-40,consisting of Acceptance of Referrals for Evaluation & Treatment of Radiation Injuries & Decontamination & Treatment of Radioactively Contaminated Patients

ML20092J913
Person / Time
Site:	Limerick
Issue date:	04/23/1984
From:	Brisbon D, Earley L PENNSYLVANIA, UNIV. OF, PHILADELPHIA, PA
To:	Linnemann R RADIATION MANAGEMENT CORP. (RMC)
References
OL-A-040, OL-A-40, NUDOCS 8406270305
Download: ML20092J913 (69)

Text

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Hospa Tal. OP" THE LJNIVEMSITY OP" 7"GNNSYL.VEN45 FED 4

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E v7,03 S um. n,c - M dk Au e.u s t 16. 1983 Roger E. 1.innemann M.D.

President Radiation Management Corporation 3508 Market Street b

Philadelphia, PA 1910!.

Dear Dr. I.innemann:

The Hospital of the (*niversity of Pennsylvania agrees to accept referrals for evaluation and treatment of radiation injuries f rom Radiation Management Corporation (M:C) and/or the nuclear power plants currently associated with R!tC's Emergency Medical Assistance Program. The clinical management and decisions regarding the need for hospitalization and/or treaccent shall be p

under the direction of Richard A. Cooper

!!.D., whose decisions regardina

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sans shall be final.

The Hospital of the University or Pennsylvania has and will maintain the clinical and medical capability which in the Hospital's juddenent are necessary to treat persons injured as a result of overexposure to ionizing radiatien.

The Hospital does agree to make its clinical facilities and clinical capacity available for radiattor. injury victims referred to it by R2!C and/or its participants in the Erergency Medical Assistance Program. However, under no circumstan:es will the Hospital's responsibility for patients commence until their arrival r.n! adnission at the Hospital. The Hospital will maintain a Radiation Emergency Coordinating Committee which will hold annual meetings to review accident cases and update knowledge twgarding radiation injuries and procedures, and will hold annual training and drill sessions for staf f in the care of radicactivelv enntaminated patiente and in the evaluation of over-exnneure to radiation injurien.

Radiation Management Corporation will assist the Hesrital in maintolnin: its capabilities to handle radiatien injurfes by providing consultation and radiation laboratery support on a rotular basis.

This agreement replaces and supercedes all previous contracts and understandings, which are hereby declared to be void and without effect.

This agreerent is offective August 1.1983. for a period of one year. to he renewed autsmatically until 1nd unless ter,inated by wixty days notice from the Hospital or R!tC to the appropriate ronregentative of the other partv.

U.S. NUCLEAR REGULATORY COMMISS l

EXHl81T No. __

'M Applicant. 'C.~ Staff _ latervenor.._ ___

lentified._ Received C Rejected._

e4%270305$40523PDR ADOM 0 0003S2 Date"'

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Reporter: 2C&bm POR M--

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cRoger E. Linnemann, M.D.

Radiation Management Corporation Auaust 16.-'1983 Page 2-Please indicate your assent.to the provisions of this agreement by

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signing as indicated below and ' returning a copy to the Hospital. Thank ynu very much.

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,, Rope ( %. Linnemann, M.D.

Delores Brisbon 4

-ForkapiationManagement For the Hospital of the University

.Cprporation of Pennsylvania omf.

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,t Laurence E. Earley, it.D.

Chairman Department of Medicine

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A XCONTAMINATION AND TREATMENT -

0F THE RADI0 ACTIVELY CONTAMINATED PATIENT

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AT HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA

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DECONTAMINATION AND TREATMENT I

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tI THE RADI0 ACTIVELY CONTAMIllATED PATIEllT

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AT HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA f

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l TITLE PAGE NO.

1.0 GENERAL,..................

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' 2'.0 COMPOSITION AND RESPONSIBILITIES OF RECCHUP.

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2.1 Conposition 1

2.1.1 Chat rman 3

2.1.2 -

Menbers 2.2 Responsibilities 2.2.1 Policy and Procedures i

2.2.2 RECCHUP Meetings 2.2.3 Availability and Response 3.0 CONSULTATION OR TREATMENT..........

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i 3.1 General 3.2 Cases Presented by Staff Manbers of HUP or e

Non-Staff Physicians i

'3.3 Unannounced Arrival of Radiation Casualty at Emergency Room l

n 3.4 Inquiries or Requests for Assistance j.

3.5 Referrals from Associated Industries and Insti-i tutions l

I 3.5.1 Usual Procedures i

3.5.2 Unusual Procedures 4.0 HOSPITAL ADMISSIONS.............

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4.1 Preparation of Radiosurgery Decontamination r

Suite 5.0 RADIATION PROTECTION AND MONITORING OF ATTENDA!1TS l-

-6.0 TELEPHONE DIRECTORY OF ESSENTIAL PERSONNEL 7.0 AUDIT OF DECONTAMINATION / TREATMENT ROOM j

8.0 -

PUBLIC RELATIONS..............

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TABLE OF CONTENTS'(Continued)

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TITLE PAGE NO.

9.0 AMEN 0MENTS AND REVISIONS..........

6 10.0 DISTRIBUTION................

7 11.0 SETUP OF DECONTAMINATION / TREATMENT ROOM 8

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ATTACHMENTS ATTACHMENT A QUICK SORT PROCEDURE FOR HANDLING ANY RADIATION ACCIDENT VICTIM ATTACHMENT B PROCEDURE FOR RADIATION ACCIDENT EMERGENCIES SWITCH 8OARD PERSONNEL ATTACHENT C ADMISSION OF RADIATION ACCIDENT CASUALTIES ATTACHMENT D EMERGENCY TREATENT OF RADIATION ACCIDENTS ATTACHMENT E PROCEDURE FOR THE USE OF PROTECTIVE CLOTHING AND DOSIMETERS AT,TACHMENT F PROCEDURE FOR PATIENT DECONTNtINATION AND SAMPLE r

TAKING ATTACHMENT G PARTS LIST FOR DECONTAMINATION AND SNfLE TAKING l

KITS ATTACHMENT H RADIATION EitERGENCY AREA STORED SUPPLIES AND EQUIPMENT ATTACHMENT I EARitARKED SUPPLIES AND EQUIPMENT ATTACHMENT J RADIATION EMERGENCY TELEPHONE DIRECTORY ATTACHMENT K LOCATION OF MANUALS ATTACHMENT L PERSONNEL 00SIltETRY LOG & PATIENT DATA SHEETS ATTAdi4 MENT M AUDIT REPORT 4

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. ADMISSION ANO ltANAGEM NT OF RADIATION INJURIES

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AT-jHOSPITAL0FTHEUNIVERSITYOFPENNSYLVANIA 1.0 '

GENERAL

' In 1970 the Hospital of the University of Pennsylvania (HUP) established a formal protocol for the admission and management of radiation casualties

- and designated a c'ontrolled area.within the hospital (Room

. Emergency

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Room) for the reception, decontamination and emergency treatment of such casualties. This action by HUP was taken in recognition of the expanding use of nuclear materials in industry, adicine and research in the Greater Delaware Valley. Though the incidence of serious radiation accidents is

- expected to remain low, it was realized that prudent planning clearly indi-l cated the need for a centralized Radiation Medicine Center that would pre-clude the uneconomical proliferation of costly and infrequently required definitive care facilities in many hospitaIs throughout the area. Accor-dingly, with the assistance $f Radiation Management Corporation (RMC),

a corporation founded by eight mid-Atlantic public utility coganies to manage their radiatieriomrgency edical programs, the policies and pro-cedures for the admission and management of radiation casualities at the Hospital of the University of Pennsylvania have been developed. This

'documsnt expresses these policies and specifies the required proeddures.

2.0 CONP051T!0N AND RESPON5!BILITIES OF RADIATION EMERGEliCY C00RDINATING Colf9tTTEE, HOSPITAL 0F THE UNIVER$!TY OF PENNSYLVANIA (RECCHUP)

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2.1.1 ClW anant sPresident, Radiation Management Corporation - liedical Services.

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.COMPOSITIONANDRESPONSIBILITIESOFRECCHUP(Continued) 2.1 l! g g g i: General Manager, Medical Services, RNC Representative Administration, HUP Representative, Department of Medicine HUP Representative Department of Radiolog HUP Representative, Department of Nursing Service HUP Representative Emergency Department HUP Representative, Department of Surgery, HUP Representative, Radiation Safety Office, University of Pennsylvania 2.2 Responsibilities 2.2.1 Policy and Procedures Written statements of policy and precedures for the admission and manageant of radiation casualties at HUP shall be prepared, distributed to involved

' individuals, tested periodically, and reviewed annually.

2.2.2 RECCHUP Meetinos lhe Comrittee will meet annually, at the call of the Chairman. Minutes will be maintained and distributed to the men 6ers. The Committee will consider such matters as affect HUP's status of prepartdness to admit and treat radiation casualties, including availability of trained specialists, status of supplies _and equipment, and status of training.

2.2.3 Availability and Rannonse The Committee shall assum that a trained staff is available at all times to respond to requests for consultation relating to, or for treatant of, radiation casualties.

NOTE: See Attachment J. " Radiation Dergency Telephone Dimetory" 2-

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~3.0 C0l4SULTATI0ll OR TREATHENT

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3.1 General Requests for consultation or treatment of radiation injuries may come from staff meders of HUP, non-staff physicians, unannounced arrival of. radiation casualties (emergency cases), and from industries and institutions having formal agreements with HUP and/or Rlic for radiation medical support.

3.2 Cases P.esented by Staff Meders of HUP or Non-Staff Physicians Staff menbers or physicians from the comunity having patients involved in radiation accidents will be referred to the Chairman, RECCHUP (President, RMC. Medical). The Chairman, in consultation with RECCHUP menbers, will advise the physician in accordance with the procedures of this document.

3.3 Unannounced Arrival of Radiation Casualty at Emergency Room

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Personnel on duty at the Emergency Room shall act in accordance with the instructions contained in a procedure entitled, " Quick S0RT Pro-cedure for Handling Any Radiation Victim". A copy of this procedure is appended to this document (Attachnent A); a copy is also on file in the Emergency Room.

F 3.4 Inquiries or Requests for Assistance Such inquiries or requests shall be directed to Rf1C by either telephone operator or the staff menber receiving the inquiry or request. The telephone operators are in possession of a procedure entitled, " Procedure for Radiation Accident Emergencies--Switchboard Personnel", which contains explicit instructions concerning this matter. A copy of these instructions is appended to this document (Attachment B).

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3.0 CONSULTATION OR TREATMENT (continued) 3.5 Referrals from Associated Industries and Institutions 3.5.1 Usual Procedures

-Patients may be trans# erred from " Local Supporting Hospitals" to HUP for treatment of radiation injuries. These local supporting hospitals, by written agreement with the respective firms and institutions, provide fairly extensive medical emergency support for radiation accident Y

cases. However, in the event that the patients' treatment requirements exceed the medical resources available at the local hospitals, the patient will be transferred to HUP. Under anticipated circumstances, such transfers will result from deliberations between the local hospital staff, the firm or institution medical director and the staffs of HUP and RMC.

It is also anticipated that any patient transferred from a local hospital will have been decontaminated quite effectively. Accordingly, the patients in this category, although victims of radiation accidents, are not classified as " emergencies".

It may or may not bg necessary to admit them.through the Decontaminatinn/Treatmen't Room of the Emer-gency Room Conglex.

?3.5.2 Unusual Procedures Radiation accident victims'may be medically evacuated directly from the scene of the accident to HUP or a patient transferred from a local f

supporting hospital may present a radiation contamination problem to HUP, provisions. of such unusual circumstances are required. The procedure for admitting radiation accident casualties who present a potential threat of radiation exposure or contamination are provided in Attachment C, " Admission of Radiation Accident Casualties" to this document.

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4.0 HOSPITAL-ADMISSIONS (S:e also Attachment C) i I

Every reasonable' effort will be made to admit patients who present a contamination hazard through the Decontamination /Tmatment Room of 1

the Emergency Room Coglex. Since this area is not continuously set up and staffed for admission of radiation casualties, advance noti-l fication of-requirements for these facilities should be made. As used in this document, a contamination hazard will be assumed to exist if the radiation level emanating from a patient is detectable with a j

portable beta-gamma G.M. survey meter.

4.1 Preparation of Decontamination / Treatment Room l

Upon notification of intent to admit a radiation casualty to HUP, RMC shall have the responsibility of supervising and assisting in the pre-

paration of the Decontamination / Treatment Room of the Emergency Roon Coglex.. This preparation will be accoglished in accordance with the procedure presented in Section 11.0, " Setup of Decontamination /Tmatment Room", of this document.

5.0 '

RADIATION PROTECTION AND MONITORING OF ATTENDANTS j

Attachments E & F to this document present specific operational procedures i

for personnel working in and supporting activities in the Decontamination /

t Treatment Room.

6.0 TELEPHONE DIRECTORY OF ESSENTIAL PERSONNEL t

A directory.of essential personnel is attached to this document (Attachment J).

It shall be the msponsibility of RMC to semi-annually verify that this directory is current.

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- AUDIT OF DECON1 AMINATION / TREATMENT ROOM SUPPLIES AND EQUIPMENT RMC shall. conduct a semi-annual audit of the supplies and equipment maintained for use in the Decontamination / Treatment Room.

Records of the findings of these audits shall be maintained.

Findings that adversely affect the state of readiness of this procedum shall be f

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.7.0 AUDIT OF RADIOSURGERY DECONTAMINATION SUITE SUPPLIES AND EQUIPMENT (Continued)

-l corrected immediately, if possible. Significant findings and those l

adverse findings which cannot be corrected immediately shall be brought t'o the immediate attention of the Chairman, RECCHUP. An inventory of r

~ -supplies maintained for use in the Decontamination / Treatment Room i

is shown'in Attachment H to this document.

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.8.0 PUBLIC RELATI0iis l

-Radiation accidents are a rare and newsworthy. event. Consequently, they will draw considerable public attention. Therefore, to avoid unnecessary

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alarm, misinterpretation, and misunderstanding, it is imperative that correct and concise information be given. All information concerning

.the patient.and.the accident should be funneled through a comittee of I

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~the following responsible. individuals:

Chaiman, 'RECCHUP i

Primary Care Physician Public Relations Office, HUP Medical Director & Public Relations Departme'nt of company involved.

The information on the radiation accident should be channeled by the committee members and others. involved through the HUP' Public Relations Department as the central spokesperson for news dissemination to the

-. medi a'.. The Public Relations Department will check out the information to be released with members of the committee. The channeling of infomation through Public Relations is a step toward the objective of'

assuring uniformity of.infomation ' distributed.

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-AMEN 0MENTS AND REVISIONS j

l The Secretary, RECCHUP, will submit recommendations for amendment.and/or f

revision of this' document to' RECCHUP in consequence of evaluations made during implementation of its provisions, or, as a result of his review

,J df-thedocument. He shall conduct an annual review of the document and report his findings to RECCHUP during its first meeting of each calendar

9.0 AMENIX4ENTS AND REVISIONS (Continued)

. year. He shall issue copies of. approved amendments and revisions to individualo or departments identified in paragraph 10.0 10.0'

' DISTRIBUTION Copies of this document and all subsequently published amendments ar.d revisions shall be distributed by the Secretary to the individuals and departments shown below:

Radiation Management Corporation (4 copies)

Each Menber of RECCHUP Emergency Room Anta

. Department of Medicine Department of Surgery Department of Radiology Department of Nursing Service Radiation Safety Office, University of Pennsylvania Issued for RECCHUP

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r 11.0 SET UP OF DECONTAMINATION / TREATMENT ROOM 11.1 General

~ The Radiation Emergency Area (REA) is located in the Emergency Room Complex. The Decontamination / Treatment Room is Room A supply cart (which contains health physics supplies) is located in the foyer of the Emergency Room Entrance. Refer to Diagram I for REA set-up.

Step 1 Clear out all Decontamination / Treatment Room of all supplies.

a.

b. -Lay floor covering (Herculite) throughout the REA. The pre-cut color pieces are marked as to proper location.

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1) Yellow Herculite, 3 pieces l

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Treatment Roon b.

Inside hallway from treatment room to foyer Outs. de hallway to ambulance entrance i

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2) Green Herculite a.

Buffer zone f

Note: It is layed down after patient has been delivered and ambulance attendants have exited P

3) ' White Herculite a.

Use for patient exit only Step 2 Attach decontamination table top to gurney and place 30 gallon yellow a.

water receptacle under drain, b.

Place a 30 gallon yellow water receptacle with plastic liner in Decon-tannnation/ Treatment Room.

l Step 3 Nove supply cart to Buffer Zone. _ See Diagram I for proper location.

a.

b.

Erect stanchion and attach warning rope and signs. See Diagram I for proper locations.

Step 4 Attach hose with showerhead to faucet.and adjust water temperature a.

(lukewarn).

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Step 6 a.

Leave Decontamination and Sample Taking Kits in supply cart. These supplies can be handed into the Treatment Room when needed, i-b.

Protective clothing packs and dosimetry should remain in the supply cart. The clothing should be donned as the personnel enter the Decontamination / Treatment Room.

Step 7 1

After patient has been placed on decontamination table top and the a.

anbulance attendants have exited, the green Herculite should be placed over yellow Herculite. Start at the end (right hand side as you face the room) and roll toward main entrance. The length of the green Herculite is approximately 15'.

b.

After patient has entered the Decontamination / Treatment Room, erect a rope barrier between the treatment room and hallways.

. Place a step-off pad on the floor between the doorway.

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Q4;3 Green Herculite Ol j

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--> Decontaminated Patient

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RADIATION EMERGENCY AREA 110 SPITAL OF T il E UNIVERSITY 0F PENNSYLVANIA l

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ATTACHMENT A QUICK SORT PROCEDURE FOR HANDLING ANY RADIATION ACCIDENT VICTIM i

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HUP: Revision A ATTACH!!ENT A Quick SORT Procedure for Handling A_ny.

Radiation Accident Victim at the Emergency Room Unloading Dock 1.

Ascertain whether the patient is CONTA!!INATED (Use G t Tube)

A.

If so... Admit the patient to Decontamination / Treatment Room, Roon

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If not... Admit to nonnal Emergency Room C.

If in doubt... Admit patient to Decontamination / Treatment Room

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Treat traumatic injury 3.

If contaminated, decontaminate with soap and water (in Decontamination /

Treatment Room) l 4.

Call for assistance Radiation Management Corporation (215) 243-2990 EMERGENCY (215) 24?-2950 GENERAL BUSINESS

- Department of Radiology DAY:

5 662-3000 NIGHT:

5 662-2222; ask PAGE Operator for On-Call Radiologist l

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nur; nevision n ATTACHMENT A (continued)

PROCEDURE FOR ADMISSION OF UNANNOUNCED ACCIDENT BY EMERGENCY ROOM PERSONNEL Admission Guidance is provided for the unannounced arrival of accident patients under two circumstances:

(1) Emergency Room personnel become aware of the patient's status as a " radiation accident patient" before the patient has been removed from the ambulance; and (2) the patient has been brought into the Emergency Room before his status as a " radiation accident patient" has been determined.

Patient Still in Ambulance If general medical condition warrants, sustain patient in ambulance, instruct driver, attendants, and Emergency Room personnel who have been in contact with the patient to stay in the vicinity of the ambulance (but not inside the ambulance).

-t Clear an area of about 8 feet around anbulance and keep unnecessary per-

.sonnel and vehicles away. Attend to patient's medical condition as required.

- Use surgical gloves and mask. If immediate Itfesaving measures are not neces-sary, observe patient from a distance. All equipment and supplies used to attend 2

to patient MUST stay in the vicinity of the anbulance. 00, NOT carry anything back to the Emergency Room.

Inrediately request assistance from Radiation Management Corporation, Department of Radiology, and/or Radiation Safety Officer. Then:

+ Request of Security that the Anbulance Entrance be set up as a Radiation Energency Area; a

+ Admit patient to Decontamination /Treatnent Room, Room A-2 i

HUP: Revision A ATTACHMENT A (Continued)

Patient Still in Anbulance (continued)

+ Clear every person out of Room before bringing patient in.

+ Instruct driver to stay with anbulance until a radiation survey has been made.

+ Bring necessary equipment and supplies to treat patient from Emergency Room to Decontamination / Treatment Room, Room All equipment, supplies and personnel entering Room MUST stay there until arrival of radiation monitoring personnel. Establish a guard at 'the door. Pass Emergency Room supplies and equipment into Room

but 00_, NOT allow personnel and equipnent to come out.

+ Personnel attending patient in Room should stand next to patient, only as long as necessary to perform lifesaving measures. At all other times, stand about five to eight feet back and observe patient.

Radiation Status Discovered After Admission to EneroencY Room

+Imediately secure the entire area through which the patient has passed or is located. Keep all personnel and equipment in the area. 00, NOT allow anyone or anything to leave.

+ Establish a control point through which necessary personnel k

and equipment pass into restricted area.

_ Hake arrangements to admit other patients to uninvolved area

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of Emergency Room through an alternate route.

+ Attend to patient's emergency medical condition as required.

Use surgical gloves, mask and gown when treating patient.

If imediate lifesaving measures are not necessary, observe the patient from a distance (five to eight feet). Inunediately call:

(See Telephone Directory, Attachment J)

- Radiation Management. Corporation (215) 243-2990

- Department of Radiology DAY:

(215)662-3000 NIGHT:

(215)662-2222 Ask PAGE Operator for On-Call Radiologist

- Radiation Safety Office (215) 243-7187 A-3

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I ATTACHMENT B PROCEDURE FOR RADIATION ACCIDENT EMERGENCIES SWITCHBOARD PERSONNEL s

HUP: Revision A ATTACHMEllT B PROCEDURE FOR SWITCHBOARD PERSONNEL

. Procedure for Radiation Accident Emergencies 1.

Complete Data Information Sheet, seen on next page.

2.

Instruct party to wait, if at all possible, for a return call from Emergency Room Nursing Supervisor, who will provide party with ad-ndssion instructions.

3.

Call Radiation Management Corporation (215) 243-2990

+Tell them you have a radiation emergency;

+Give them the data you obtained from caller; and

+ Instruct them to call this person immediately.

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If caller must dispatch patient to llospital of the University of Pennsylvania immediately, instruct him to bring patient to the Emergency Room Entrance and wait in the ambulance for further instructions.

5.

' Check back with caller after 15 minutes to see if he received assistance and instructions.

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ATTACHMENT B (Continued) pATAINFORMATIONSHEET From Caller.

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. Date and Time of Call' Person Calling:

Name:

Address:

' Telephone Number:

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- Accident:

Location:

Date and Time:

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Type:

No. of Patients:-

From Telephone Operator Whom did you Notify at Emergency Room?

Time of Notification:

- Did You Check Back with caller?

When?:

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accident arrives unannounced at the Emergency Room is presented in Attachment A of this document.

Announced Arrival of-Radiation Accidents RMC will have received notice of an. accident with actual or suspected radiation exposure of personnel; on receipt of such notice, RMC will have sent I

out its Radiation Emergency Medical Team (REM-Team) to the site of the accident, or will have established a line of communication with the medical personnel attending the patient.

From this moment on, the REM-Team physician is responsible for coordinating the transportation of the patient to HUP.

Further action involving HUP will take place in five phases: the ALERT Phase, the NOTIFICATION Phase, the ARRIVAL Phase, the CLEAN-UP Phase, and the DEFINITIVE CARE Phase.

THE ALERT PHASE As soon as possible the REM Team physician will alert HUP of the possible referral of (a) patient (s) indicating the most probable arrival time and the nature and extent of the-patients' injuries.

l The REM-Team physician will alert the Department of Medicine member of RECCHUP (or an alternate) and this menber, will, in turn, alert other staff members of HUP as indicated below.

If the REM-Team physician is unable to contact the Department of Medicine RECCHUP member (or an alternate), he will alert the RECCHUP member representing HUP Administration, who, in turn, will alert other C-1 i

l ATTACH!iEllT C (Continued) s-THE ALERT PilASE (Continued) involved menbers of HUP as indicated below. The RECCHUP member receiving the alert call from the RiC Team physician will assure that as many essential in-dividuals are alerted as may be necessary to cope with the situation described (Attachment J).

Responsibilities of Alerted Personnel Surgery:

assure availability of an anesthesiologist and other surgeons.

Nursing:

assure availability of nursing personnel, equipment

& supplies " ear-marked" for use in Decontamination /

Treatment Room.

Administration:

itlert HUP Security, and University of Pennsylvania Security, Safety and liaintenance Departments.

Radiology:

assure availability of physicians, physicists, radio-biologists and Radiation Safety Officer (RS0).

- l1edicine:

assum availability of consultation and hospital laboratory support.

L Rf1C:

stand by ready to set up the Decontamination / Treatment Room in the Emergency Room Conplex.

THE NOTIFICATION PHASE As soon as it has been decided that (a) patient (s) will be referred to HUP

- for observation or treatment, notification will be given by the REli Team physician. This notification shall contain the following information:

- nunber and nanes of patients;

- estimated time of arrival;

- description of injuries;

- degree and type of contamination;

- special needs for equipment and/or personnel.

The REli Team physician will notify P.he RECCHUP menber who had previously been alerted. He will notify such essential individuals (Attachment J) as 'may be necessary to receive and treat the incoming patient (s).

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ATTACH!!ENT C (Continued)

THE NOTIFICATION PHASE (Continued)

Responsibilities of Notified Personnel R!iC:

+ Supervise and assist in the setting up of the Decontamination / Treatment Room in Emergency Room Coglex.

+ Appoint a person to the control point. The duties of this person am as follows:

+ Restrict access to personnel authorized entry by the attending physician or the nursing supervisor;

+ Assure that the personnel entering the Decontamination /

Tmatment Room are wearing protective clothing and personnel dosimeter; 4taintain a record showing name of person entering Decontamination /Tmatment Room, personnel dosime-try nunber, and time df ingress and egress from Decontamination /Tmatment Room;

+ Assure that no person or thing is allowed to leave the Decontamination /Tmatment Room (after the radio-actively contaminated patient is admitted) until they or it have been monitomd and found to be

" clean", i.e., fme of detectable radioactive contamination.

Administration:

+ Assure that the Security Department is instructed to perform the following duties:

+ Clear vehicle access to the REA Entrance;

+ Post guards at Emergency Entrance;

+ Contact Security, Safety and Maintenance Departments.

. University of Pennsylvania, to assist in any prepara-tion of Murphy Field for arrival of helicopter (if necessary.

C-3

4' ATTACHMEliT C (Continued)

THE NOTIFICATION PilASE (Continued)

Administration (Continued):

+ Alert Public'Relat' ~ s, Plant Operations, Housekeeping and such departments as may become involved.

Surgery:.

+ Request surgeons and anesthesiologists to 90 to Emergency Room Conference Room for briefing;

.+ Assure that mquired equipment is ready for use.

' Radiolonv:

+ Assign staff menber to go to Emergency Room to assist in preparation of area and to. assist in radiological matters, including diagnostic X-rays.

. Emeroency Roor Charge Nurse:

Obtain notification that a radiation injured patient admission is

-imending and/or a patient arrives at the Emergency Room for treat-

1) Obtain the necessary medical supplies and take to the Decontamination / Treatment Room;

2) Insure that a stretcher is brought to the REA

'and left outside the Buffer Zone.

It will be used for patient exit;

3) Assign nurse to work in the REA; a) At least one nurse in the Decontamination /

~ Tmatment Room.-

b) One nurse in the Buffer Zone.

c) One nurse outside Buffer Zone.

Medicine:

• Assign a department representative to assist in the bn ifing at the Emergency. Room Conference Room and be available for consultation and laboratory support (e.g., chromosome analysis).

C-4

s.

ATTACHMENT C (Continued)

THE ARRIVAL PHASE Security & Safety Departments, University of Pennsylvania Helicopter Arrival: As soon as the helicopter lands, notify the liedical Director, HUP, secure the area around the helicopter, assist in movement of the patient to HUP; and hold the helicopter and crew until they have been cleared by a radiation survey.

Physician in Charne: The physician will don protective clothing and wait in the Decontamination /Treatnant Room for the arrival of the patient.

After the anbulance attendants have placed the patient on the decon table top, the physician in charge will ascertain the medical status of the patient. The Radiation Safety Officer and/or R!1C will evaluate the radia-tion and contamination status of the patient, anbulance penonnel and the anbulance. He will advise the physician on. radiation safety precautions to be followed.

Arbulance Attendants and Litter Bearers: The ambulance attendants and litter bearers will return to the anbulance with their equipment and wait until they have been monitored. If contamination is found they will be instructed regarding decontamination and they will be re-surveyed prior to leaving the hospital.

Only persons and equipment necessary for patient care and treatment will be permitted in the Decontamination / Treatment Room.

NOTE: After the arrival of the contaminated patient, all persons or itens leaving the Decontamination / Treatment Room will be monitored for radioactive contamination at the control point. Persons or items found to be contaminated will be decantaminated before leaving the REA. Should there be a nurber of patients, the Emergency Room hallway (see Diagran I) will be used as the triage area.

C-5

5 ATTACH!4ENT C (Continued)

THE ARRIVAL PHASE (Continued) f In this instance, the warning rope and stanchion will be moved r

to a position that will enclose the entire hallway area. Atten-i ding personnel will don protective clothing prior to entering the arsa.

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4 C-6 l.

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I ATTACHMENT C (Continued) f THE CLEAN-UP PHASE 1

After the patient has been moved from the Decontamination / Treatment Room to the main hospital, attending personnel will proceed with removal of protec-tive apparel, personnel monitoring and decontamination in accordance with pm-l cedures given in Attachment E.

RMC will decontaminate equipment and facilities in the Decontamination /

Treatment Room and will collect and dispose of non-salvageable items.

As soon as convenient, following clean-up activities, all personnel who are involved in the care or treatment of the patient will attend a post-acci-dent conference. The conference will cover such subjects as:

+ Medical review of the event; Aperational review of the event; Q

+ Exposures incurred by attending personnel;

+ Requirement for bioassy of attendant personnel; and

+Recomendation for future handling of the radiation casualties.

Following the post-accident conference, RMC will submit a complete report of events to RECCHUP, regulatory authorities, and to the Medical Director or consultant of the conpany responsible for the accident.

i t

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C-7

c.

ATTACHMENT D 4

EMERGENCY TREATMEtiT OF RADIATION ACCIDENTS e

'S 1

ATTACHMENT D EMERGENCY TREATMENT OF RADIATION ACCIDENTS i

GENERAL Emergency. treatment of radiation accidents may have to be given before

. contact with or. arrival of specialists having expertise in evaluation and management of these accidents. In this case the management of the patient should take place in the following order:

+ Resuscitation and Stabilization

- Initial Decontamination

- Evaluation of Radiation Status

- Initial Treatment of Radiation Injury RESUSCITATION AND STABILIZATION-Since radiation injury is net immediately life-threatening, primary attention

(,,,

should always be directed to traumatic life-threat.ening injuries -- maintenance of airway, arrest of bleeding, treatment of shock and control of pain.

DECONTAMINATION Ccncomitantly with the procedure above, or as soon as possible, the patient should be decontaminated. In the initial decontamination......

- Remove all clothing;

- Obtain samples of contamination (skin smears, tissue. fluids, etc.);

- Survey with a G-M tube and note levels of contam-ination on Patient Status Record Sheet and on Patient Data Sheets.

(See Attachment L.);

- Remove obvious dirt and debris; bathe, if necessary while protecting wounds;

- Repeat surveying and sampling as necessary; D-1

a ATTACHMENT D (Continued)

DECONTAli! NATION 'Corninued)

~

flush wounds with copious amounts or sterile water and/or saline; flush orifices with water or saline. Do not allcw pstient to swallow;

+Stop with initial decontamination when activity levels are measured in the few thousand counts / minute

+See Attachment E for details on decontamination and sample taking.

EVALUATION OF RADIATION EXPOSURE STATUS History:

-When did the accident occur?

-Source of accident?

-Type of radioisotopes involved?

-How long was patient in accident environment? Where was he in relation to radiation source? Was there airborne contamination?

Was the patient wearing breathing apparatus? Was there surface contamination? Any skin broken? Was source in contact with body?

Was the patient wearing dosimeters?

Dose Evaluation: This will require the assistance of persons knowledgeable in' radiation. This assistance can be by someone on location or by telephone.

In any case, gather.as much of the following information as possible:

-Dose rate (gamma, X-ray, neutrons, etc.) as measured by instruments

~

in accident environment;

+ Surface and air contamination in accident environment;

-Radiation exposure reading on patients' and others' dosimeters (TLO, film badge, " pencil" dosimeter);

-level of residual contamination (beta, gamma) on patient using survey meter (mark areas on Patient Data Sheets -- See Attachment L.);

-Neutron exposure? Collect metal objects, hair or nails; and

-Calculation of dose to the patient and to attendants.

D-2

r ATTACHMENT D'(Continued)

~._

Clinical picture: A good estimation of the severity of the patient's external.

[

total body exposure can 'be obtained by observing the following clinical symptoms l

and signs:

i Nausea and vomiting...

100R*

l Beginning within 2 hours2.314815e-5 days <br />5.555556e-4 hours <br />3.306878e-6 weeks <br />7.61e-7 months <br /> - >400R Beginning after 4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br />

<200R i

None within 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br />

< 75R Erythema... >300R (total body); >600R (surface contact)

" Diarrhea... >400R j

CNS symptoms... >2000R to the head

{

Serial lymphocyte count within 48 hours5.555556e-4 days <br />0.0133 hours <br />7.936508e-5 weeks <br />1.8264e-5 months <br />...

t 1200/mm good prognosis 8

300-1200/mm3 guarded prognosis

~ :300/mm poor prognosis 8

i

• Roenthens,airexposure, t

'w f

INITIAL TREATMENT OF RADIATION INJURY Detailed Decontamination:

It is particularly important at this stage to remove 4

high level contamination caused by. penetrating missiles or splinters in wounds.

r Overexoosure:, Since overexposure to radiation results in a slowly unfolding l

course over a long-period of time, there is little in the way of specific

~

treatment in th'e initial. stage of the disease. Treatment is symptomatic and

- consists of making tha patient comfortable and ' allaying his fears. He may i

.. require antiemetics, fluids, sedatives an'd analgesics.

Order CBC with differential stat, at 4, 8 and 12 hours1.388889e-4 days <br />0.00333 hours <br />1.984127e-5 weeks <br />4.566e-6 months <br />. Obtain blood sample

]

Keep sample chilled in

(10 cc heparinized blood) for chromosome analysis.

i, ice water.

Internal Contamination: Except in a few instances, there is also little to offer in the way of specific treatment in the initial stages.

l i

f b

0-3

ATTACHMENT 0 (Continued)

INITIAL TREATMENT OF RADIATION INJURY (Continued)

Internal Contamination (Continued): Generally, specific treatment to eliminate any absorbed radioactivity requires rather detailed and complex analyses, including bioassay of excreta and blood, and whole body counting.

Begin 24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> urine collections and 72 hour8.333333e-4 days <br />0.02 hours <br />1.190476e-4 weeks <br />2.7396e-5 months <br /> fecal collections. Arrange for whole body count as soon as patient's condition warrants. Arrange for thyroid uptake study for I-131.

If it has been determined that an appreciable amount of radioactivity has been ingested..(which is seldom the case), a stomach lavage, emetics (ZnSO ) or catharties (10". MgSO ) may be indicated.

4 4

If it has been determined that the patient absorbec considerable amounts of...

Tritium (3H)..... force fluids Radioiodine..... give Lugol's solution or other thyroid-blocking l

agent immediately PRINCIPLES OF RADIATION PROTECTION Certain precautions to minimize exposure to attendants are necessary when dealing with a patient who has external contamination, specifically:

Always wear surgical scrub suits, masks, caps and glovest j

Use the radiation shield in unknown or high levels of patient contamination (greater than SR/ hour' gamma radiation) when treating patient; As few attendants as necessary should be in the same room with patient; Only in the performance of emergency treatment and initial decontamination At all other times, e.g., while should attendants be next to patients.

evaluating the patient, attendants should stand at least five to eight feet from the patient and observe him from a distance; Rope off and control the area in which the patient is being treated.

AL'. persons, equipment and supplies that enter this area MUST stay

-tnere until Radiation Emergency Teams arrive to assist in ene monitoring and decontamination of people ano equipment; i

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).v. l l l -ll. f. *E ~ h ATTACHMENT D (Continued)

PRINCIPi.ES OF RADIATION PROTECTION (Continued)

Suggested permissible levels of attendant exposure in the course of treating a patient are:

to SR

...... routine treatment and decontamination to 25R

...... emergency treatment and decontamination

-to 100R...... lifesaving treatment and decontamination To estimate attendant exposure, pass the probe of the G-M survey meter with the beta window closed 6" above the patient.

If the reading is SR/ hour, an estimate of attendant exposure would be 5R; treatment should teke one hour, if performed without a shield. With a shield, the dose will be reduced by approximately 80%.

Experience shows that it is extremely unlikely that an accident would be so severe that an attendant would receive an exposure of even SR.

In high radiation fields personnel may be rotated in' order to minimize the exposure to any single individual.

It is also suggested that anticipated N

exposures over SR shou d be on a voluntary basis.

b l

INITIAL BICASSAY SAMPLES i

Each of the following bioassay samoles should be' obtained as soon as possible and labeled with'name, date, time and type of specimen. Avoid cross-contamination of samples frhm external sources of contamination or from other samples.

- Blood:

(1) 10 ce for radiobioas' :'

(2) 5 cc (heparinized) fu ctn y.,ames; keep samples chilled

', in a glass of ice; (3) 10 cc. Oxylated for hemogram and differential *

(4) 10 cc for:

(a) chemistries; (b) electrolytes

• differential - repeat t.i.d. for 3 days or more frequently if clinical condition warrants.

D-5

ATTACHMENT D (Continued)

INITIAL BI0 ASSAY SAMPLES (Continued)'

+ Hair, nails, metals from neutron-exposed patient;

- Urine:

(1). first arine; (2) _- 24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> urine for several succeeding days

+ Feces. total sample for several succeeding days;

+ Sputum;-

- Vomitus;

- Tissue and tissue exudates (note location);

'+ Irrigation fluids (note location); and

- Filter paper or cotton smears of orifices, wounds, skin areas (notelocations).

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ATTACHMENT E PROCEDURE FOR THE USE OF PROTECTIVE CLOTHING AND DOSIMETERS

^-

ATTACHfiENT E To prevent personnel from becomino contaminated with radioactive materia 3

protectiva clothing essentially consisting of the same items normally use surgeons in the operating room, i.e., a scrub suit, surgical gown, latex glo and a surgical mask 'and cap, augmented by shoe covers and a vinyl apro All work past the Control Point requires protective issued at the Control Point.

clothing, independent of the degree of contamination present on the patient or his clothing.

Each person entering the Decontamination / Treatment Room should After gross decontamination is comleted, the outer surgical vinyl aprons.

Wound care and decontamination will then gown', gloves and apron are removed.

be attended to.

Removal of Contaminated Protective Clothing

Room,

-Upon ;o@letion of their activities in the Decontamination / Treatment personnel will proceed to the rope between the Decontamination /Treatne j

b and the Buffer Zone (Diagram I). They will remove their protective clothing and personnel dosimeter in the following order:

(1) dosimeters;-

(2) tape (if any);

(3) surgical gowns (tuming them inside-out);

4 (4) headwear; (5) mask; (6) footwear; (7) gloves.

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y ATTACHliENT E_ (Continued)

Clearance Procedures _

After having removed protective apparel, each person who occupied the Tr Area will be monitored by health physics technician or by the Control Point nurs If no contamination is found, personnel may proceed to the change area a After a final check at the Control Point they will be on their normal clothing.

cleared to enter the uncontrolled area.

If contamination is found they will remain in the Decontamination /Treatmnt A he'alth physicist tech-Room and will be instructed to decontaminate themselves.

nician will guide them through the decontamination and re-survey them.

Use of Dosineters Dosimeters will be supplied at the Control Point to all personnel enterin Decontamination / Treatment Room.

Dosimeters am cf three types:

Direct reading dosimeters (" pen-dosineters") to monitor exposed 1.

on a continuing basis.

they are distributed to each attendee.

Badge dosimeters - to form a permanent record of exposum.

2.

Ring dosimeters - tn form a permanent record of finger exposure.

3.

Dosimeters am to be wom in the following manner:

- At the neck line_, clipped under the protective clothing;

- On the rinq fingers _ of hands, under the gloves, with detecting element at palm surface.

Upon leaving the Decontamination /Tmatment Room the wearer s f

dosimeter to the Control Point attendant, who will record the reading and ig the pen dosimeter and retain the badge and ring dasinaters for later pmcess The Control Point attendant must assure that the mcords clearly show i d the nunter of each dosimeter and period of time worn by each individual who occup Decontamination /Tmatnent Room.

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i ATTACHMENT F PROCEDURE FOR PATIENT DECONTAMINATION AND SAMPLE TAKING D

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I ATTACHMENT F 1

General These procedures cover the use of the Oecontamination and Sample-Taking Kits. The kits provide all the necessary items for the decontamination of a radioactively contaminated patient and the collection of specimens of this Econtamination.

The collection of specimens is a prerequisite for a thorough evaluation It should be performed in 7

of the medical and radiation status of the patient.

conjunction with patient decontamination.

There is also

' Attachment G. provides a. parts list for each of the two kits.

Following use, the lists should be consulted for a parts list in each kit.

h

.The intended use of several of the items is indicated on t e replenishment.

parts list.

Patient Decontamination Procedures Principles.

~

The objectives of decontamination are:

1. ' to prevent injury caused by the presence of radioactive substances on the body; to prevent the spread of contamination over and into the patient; and t-2.

to protect attending personnel from beccming contaminated themselv 3.

or.(in ' extreme cases) from being exposed to a source of radiation.

Although ' decontamination should be started as soon as possible, prim attention should be given to the alleviation of life-threatening conditions created-by traumatic injury.

Decontamination is essentially the physical removal of radioactive dir Most decontaminants contain detergents fro.m the skin, wounds, or body orifices.

I F-1 e

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~^^~~~~~e.

ATTACHMENT F (Continued)

Patient Decontamination procedures (Continued)

Therefore most decon-or other chemical agents to facilitate this removal.

taminants are suitable for decontamination of the intact only, i.e., are not ' appropriate for wound cleansing or irrigation of body orifices.

. Decontamination is performed in the following manner:

from the highest level of contamination to the lowest; 1.

starting with the simplest procedure (e.g., soap and water) to more 2.

complicated procedures; 3.

with due regard to contamination of wounds, body orifices, etc. (see below for specific guidelines).

'Usually, the effect of decontamination is greatest in the earliest stages, i.e., most of the radioactive material is removed during the first decontamination At some Continued decontamination may show diminishing effectiveness.

effort.

point a decision has to be made to either accept some residual contamination, or proceed with the use of more potent decontaminants (more specific guidelines i

are seen below).

Steps to be Taken for Decontamination In some cases decontamination may have been started before the patient arrives at Piersol Rehabilitation Suite.

It can be expected that the residual contamination is minor and/or that serious contamination is localized, e.g.,

Before decontamination, the following steps should

~

around and.in a wound.

be taken:

Judge whether the patient's 9edical condition requires immediate 1.

intervention; stabilize wound, if necessary, and redress for later decontamination; obtain a briefing from the radiation physicists as to the contamination 2.

status of the patient, the exposure of the patient, and as to the F-2

P 7=

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ATTACHMENT F (Continued)

'Steos to be Taken for Decontamination (Continued)

Especific measures to be taken by attending personnel with regard to their protection; remove 'all clothing and' monitor the patient with the radiation survey 13.'

instrument by scanning the entire body (holding the probe about two

' nches from the skin), and record the findings on the Patient Data i

Sheets.. Patient sampling should be done at this point - nasal swabs,

skin swipes, hair, nails, blood samples, etc.;

4..

perform a gross decontamination (see Decontamination Procedures w follow);

clean up room'and remove outer garments from attendants; 5.

proceed with wound survey and decontamination;

.6.

complete detailed decontamination of patient; 7.

transfer patient to " clean"_ area of hospital.

8.

Decontamination Procedures

General

.Two general rules apply to the performance of decontamination:

check the effectiveness of the technique applied by monitoring 1.

periodically; and

. avoid the spread of radioactive materials from the area being decontam-2.

inated to areas of lesser contamination by covering the adjacent area.

Except when prohibitive degrees of contamination are present on/

the' locations listed below, decontam, nation is performed in the followin 1.

high-level intact skin; 2.

. body orifices and adjacent skin; F-3

r ATTACIIMENT F'(Continued)

Decontamination Procedures _ (Continued)

3.'

wounds and adjacent skin; 4.

low-level. skin areas.

Decontamination of Skin take -srear sample of area (see " Sample Taking Techniques and 1;

' Indications", page F7);

protect-adjacent area if indicated by covering with towels; 2.

3. f cleanse skin area; wash thoroughly with Turco soap and tepid w using either cotton balls,. preoo sponges or surgical brushes; cover area with a good lather; rinse off after two to three minutes with copious amounts of running water; monitor; record results.

if contamination persists, repeat step (3) once 4.

if contamination still persists, try gentle application of clorox or

'5.

Avoid any of these entering wound or body hydrogen peroxide. NOTE:

Repeat a few times using new cotton balls; remove decon openings.

with water; monitor; record results.

6.

af ter complete decontamination dry skin and apply Nivea cream to abrased or injured areas.

if residual contamination is present, consult with radia, tion spe 7.

to decide whether further efforts are indicated; if it is decided to accept residual contamination, dry the skin and apply colloidon Dermaplast, mark the area involved and record;

8. - collect all mater.ials used and place in separate labeled con In case of serious contamination around a wound, rapid removal of the bulk of radioactivity can be obta tiOTES:

nails, clip nails, remove hair and scrub thoroughly and shaving.

repeatedly with intermittent surveying.

F-4

g; ATTACHMENT F (Continued)

Decontamination of Body Orifices take samples of activity in nostrils, ear canals, and other orifices 1.

as indicated (see " Sample Taking Techniques and Indications", page F7);

decontaminate area surrounding orifices; 2.

gently clean orifices using wetted swabs; 3.

if nose swab indicates significant radioactivity in nasal cavity, 4.

use nasal blows and nasal irrigation; collect all materials used and label containers.

5.

Decontamination of Wounds use aperture drape to isolate the contaminated wound; 1.

1 survey and take samples of wound (see " Procedures for Sample Taking, 3

2.

]

J page F6);

decontaminate skin adjacent to wound; 3.

depending on surface and depth of wound, irrigate wound with sterile 4.

j saline, dab with gauze pads soaked in sterile saline to cleanse wound; l

collect all materials used and place in separate labeled containers; remove obviously necrotic and devitalized tissue surgically; keep all

'i 5.

tissue specimens removed; j

repeatedly monitor wound; record result on patient record _ sheet; 6.

g if contamination persists, consult with RMC to determine further course 7.

I of action; if wound is clean, treat wound as necessary.

i l

8.

ATTACHMENT F (Continued) k Procedures for Sample Taking Principles The objectives of collecting specimens from a radioactively contaminated pat!ient are as follows:

il to evaluate the amount and composition of the radioactive contaminants

~

on and in the body;

2..to obtain data with regard to the patient's exposure to external radiation; and

.to supply information on the biological injury inflicted by the 3.

4

. irradiation.

To meet.these objectives, the following types of specimens are collected routinely:

materials containing the external contaminant (swabs, smears, tissue 1.

samples, contaminated cleansing fluids, etc.);

specimens'containing internal contaminant (feces, urine, sputum, etc 2.

in case of neutron irradiation.... materials in which neutron induce 3.

radioactivity may be present (gold rings, buttons, hair, nail clippings); and hematological specimens (whole blood in heparinized, oxalated, and n

4.

uncoated tubes; blood smears).

' As the analysis of radioactive samples with regard to their composition i s _only possible in samples with a relatively high radioa'ctivity, care shou t

be taken to collect and store these samples separately from the usually bulky samples with rather low radioactivity (such as cleansing fluids, drapes, etc.).

o e

F-6

ATTACHMENT F_ (Continued) i Procedures for Sample Taking (Continued)

A sample which is not identifiable as to its source (location, time taken may be practically worthless; therefore, take care to properly collect, stor and mark _all samples.

Sample Taking Techniques & Indications External Contamination:

Before decontamination, the following samples shall be obtained:

use Nucon smear pads, moisten with a few drops of water, 1.

Skin Smears:

and smear a skin area of about 100 cm2 (4"x4"), if possible, by allow-ing sticky side of the smear to adhere to gloves and rubbing the smear pad over the surface to be sampled; place smear on record pa 2 and record location and time and area smeared, if other than 100 cm place in envelope.

Take samples of nails, hair and collect metallic objects (rings, watch 2.

. glasses, belt buckles, etc.).

use either one of the following methods:

3.

Wound Samples:

-for large wounds with visible blood or wou and label;

-for superficial wounds -- rub gently with cotton swab; return to tube and label;

-for wounds with visible dirt or debris -- remove with cotton tip or use tweezers; transfer sample to small glass vial and label.

Internal Contamination _

wet Q-tip with a few drops of water; swab, and store 1.

Body Orifices:

in waterproof envelope and label.

colle:t urine

2. In all cases where internal contamination is expected:

and feces in containers supplied, and record time of voiding.

F-7

~

s ATTACHMENT F (Continued)

Sample Taking Techniques & Indications (Continued)

External Exposure:

In all cases where a total body exposure is suspected:

obtain 10 cc of oxalated blood for complete blood count and 1.

differential; obtain 10 cc of heparinized blood far chromosome analysis; 2.

obtain 10 cc tlood for electrolytes and chemistries.

3.

Record time these samples were taken.

e F-8

f:.

6 ATTACHMENT G t

PARTS LIST FOR DECONTAMINAT10tl AND SAMPLE TAKING KITS G

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ATTACHMENT G_

7 DECONTAMINATION KIT _

Quantity Skin Decontamination 260 Absorbent balls, extra large 1

. Sponge-holding forceps 2

Plastic beaker, large 6

Preop Sponges

)*

10 Surgical Scrub brushes 1

Wash bottle -(for localized contamination)

Decon....:nants (Skin only) l 1

Turco decon soap, bottle (for first decon effort; general) 1 Clorox,_ bottle (for second decon effort) 1 Hydrogen peroxide (H 0 ), bottle * (for third decon 22 effort)

Wound Cleansing 50 Gauze pads, sterile 8 pair Sterile Surgical Gloves, assorted sizes Solution bowl, plastic 1

Syringe, 50 cc 100 Cotton-tipped applicators 1

Aperture Orape

• shelf life - 3 years F

I O

G-1

ATTACHMENT G (Continued)

DECONTAMINATION KIT _ (Continued)

Quantity Decontaminants (Wounds) 1 Saline solution, normal *, sterile bottle Betadine Solution, Providone-Iodine, bottle 1

Treatment Agents 1

Nivea cream, jar 1

Colloidin, bottle

~

1 Potassium Iodide *, bottle Miscellaneous Materials 1

Prep kit 1

Scissors, heavy duty, HARE paramedic 12 Patient Radiation & Medical Status Anatomical Diagrams 8

Plastic bags, assorted sizes (to hold decon materials after use) 1 Tissue paper, box 1

Notebook 2

Pencils-1 Finger-Nail Clippers

• shelf life = 2-3 years G-2

ATTACHMENT G (Continued) t SAMPLE TAKING KIT (for one patient)

Sampling Instrument Quantity Sample Type 4

swabs

. Nasal 4

swabs

- Aural 4

swabs Oral 4

swabs Skin Folds 25 slots Nucon smear Swipes -

4 small container Hair 4

small container

' Nafis 2 small Metallic Objects medium container /

2 large plastic bags 10 cc vacutainers 2 heparinized Blood (green) 1 oxalated (gray) 1 sterile (red)

Urine (24-hour) 2000 cc plastic container 1

2 fecal container Feces 4

swabs Wound Exudate 2

eyedropper & bottle

. 2 small containers Tissue 2 medium 2

Vomitus fecal container 2

100 cc plastic bottle Irrigation fluids (10) Envelopes (50) Labels (2)

Pens......(1) grease; (1) writing (1) Scissors (1) Tweezers (1) Clippers G-3

es ATTACHMENT H_

RADIATION EMERGENCY STORED SUPPLIES & EQUIPt4ENT 3

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l-ATTACHMENT 1 EARPARKED SUPPLIES & EQUIPMENT

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O ATTACHENT I EARMARKED SUPPLIES & EQUIPMENT.

t Earmarked supp1fes and equipment necessary for stabilization of the be brought from the Emergenr:y Room.

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RADIATION EMERGENCY TELEPHONE DIRECTORY l

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ATTACHENT J RADIATION E!ERGENCY TELEPHONE DIRECTORY Office Home Hosoital of the University of Pennsylvania Emeroencv Room (215 662-3920 Main nurber Sheldon Jacobson, M.D. (Chief)

(215 662-6963 527-6199 Howard Henze (Administrator)

(215 662-3903 543-2247 Nursing Service 662-2604 Main number 662-2614 EV-6-3411 Nadine Landis, R.N.

662-2603 EV-6-2441 Mary Rieser, R.N.

Department of Radiolocy_

(215) 662-3049 625-0271 Harold Goldstein, M.D.

(215) 662-3069 642-0248 Abass Al avi, ' M.D.

Department of Suroery (215)662-2020 ftU-0-7662 Henry Berkowitz, It.0.

Departmnt of Ibdicine (215) 662-3910 664-1284 Richard Cooper, it.D.

hetment of Patholoav_

(215) 243-8061 LO-6-7243 Peter Howell, M.D.

(215) 243-0066 (Lab)

(215)662-2271 Administration (215) 662-3957 Administrator's Office Radiation Safety Office (215) 243-7187 (215) 688-8646 John Thomas (215) 662-2677 Security Department. HUP' Security. University of Pennsv1vania Helicopter Clearance (Canous police)

(215) 243-7297 (215) 243-6921 Safety Office Fine & Safety (215) 533-7678 Frank Esposico J-1

= - -

ATTACHMENT J (Continued)

RADI ATION EMERGENCY ' TELEPHONE DIRECTORY i

' ' Radiation Management Corcorat on 243-2990 Emergency Nurter (24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br />) 243-2950 General Business Nurter 1

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r ATTACH!iENT K e

LOCATI0il 0F 1%NUALS WNS g

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.9 ATTACHMENT K LOCATION OF MANUALS Radiation Management Corporation Copy #1,2 James T. Bninnan, M.D.

Copy #3

- Robert H. Sawyer, M.D.

Copy #4 Hospital of the University of Pennsylvania Richard A. Coo Copy #5 Paula Levine (per, M.D. (HUP Hematology)

HUP Administration)

Copy #6

. Peter C. Howell, M.D. (HUP Pathology)

Copy #7 John Thomas (HUP R.S.O.)

Copy #8 Copy #9

' Mary Rieser (HUP Nursing) )

Nadine Landis (HUP Nursing Copy #10 Harold Goldstein (llVP Radiology)

Copy #11 Sheldon Jacobson, M.D. (HUP Emergency Services)

Copy #12 Gene Cayten. M.D. (HUP Surgery)

Copy #13 Energency Room Anna Copy #14

-Radiation Emergency Supply Cart Copy #15 Department of Medicine Copy #16 Department of Surgery Copy #17 Department of Radiology Copy #18 Department of Nursing Copy #19

stadiation Safety Office, University of Pennsylvania Copy #20 1

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