ML20106C206

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Rev 6 to Decontamination & Treatment of Radioactively Contaminated Patient at Salem County Memorial Hosp
ML20106C206
Person / Time
Site: Hope Creek PSEG icon.png
Issue date: 10/31/1984
From:
Public Service Enterprise Group, RADIATION MANAGEMENT CORP. (RMC), SALEM COUNTY MEMORIAL HOSP., SALEM, NJ
To:
Shared Package
ML20106C199 List:
References
PROC-841031, NUDOCS 8502120174
Download: ML20106C206 (56)
v • d • e


Text

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Revision: 4 October,1984

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DECONTAMINATION AND TREATMENT OF THE RADI0 ACTIVELY CONTAMINATED PATIENT AT SALEM COUNTY MEMORIAL HOSPITAL e

Revision # Date d December, 1980 1 October,1982 2 March, 1984 3 June, 1984 4 June, 1984 5 June, 1984 6 October, 1984 e502120174 850207 FDR ADOCK 05000354 F ,

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Revision: 4 October, 1984 DECONTAMINATION AND TREATMENT OF THE RADI0 ACTIVELY CONTANINATED PATIENT ,

AT SALEM COUNTY MEMORIAL HOSPITAL TABLE OF CONTENTS TITLE PAGE NO. REV/DATE A. . -PURPOSE AND SIMtARY 1 3 6/84

8. PRECAUTIDNS 1 3 6/84 C. PREREQUISITES Alert / Notification
1. . 2 3 6/84
2. Prior Action at Salem Nuclear Generating 3 2 3/84 Station D. LIMITATIONS AND ACTIONS 3 2 3/84 E. PROCEDURE.
1. Notification 4 3 10/84
2. Nursing Supervisor's Duties 4 3 6/84
3. Maintenance / Housekeeping Personnel's Duties 5 _3 6/84
4. Emergency Room Nursing Personnel's Duties 6 3 :6/84
5. Attending Physician's Duties 7 3 6/84
6. Control Point Attendant's Duties 8 3 6/84
7. Buffer Zone Attendant's Duties 9 3 6/84
8. President's Duties . 10 2 3/84
9. Plant ~ Radiation Protection Technician's (RPT) 11 ,

3 6/84 Duties F. ~ RETURN OF REA TO NORMAL USE 12 2 3/84 G. PATIENT TRANSFER.T0 DEFINITIVE CARE CENTER 12 . 2 3/84 H. PROCEDURE FOR HANDLING MULTIPLE. VICTIMS 12 3 6/84

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Revision: 4 October,1984

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ATTACHMENTS

, REV/DATE DIAGRAM I AMBULANCE ACCESS ROUTE TO REA 1 6/84 DIAGRAM II DIAGRAM III ATTENDANT GARB 3 6/84 DIAGRAM IV FLOOR COVERING FOR PATIENT TRANSFER 1 6/84 ATTAC MENT A PROCEDURE FOR HANDLING ANY RADIATION 3 6/84' ACCIDENT VICTIM ATTACHENT B TELEPHONE PROCEDURE FOR RADIATION 3 6/84 ACCIDENT EMERGENCIES - NURSING SUPERVISOR ATTACHMENT C EMERGENCY TREATMENT OF RADIATION ACCIDENT 3 6/84 ATTACHMENT D PROCEDURE FOR THE USE OF PROTECTIVE 1 6/84 CLOTHING AND 00SIMETERS ATTACHMENT E PROCEDURE FOR PATIENT DECONTAMINATION AND 4 10/84 SAMPLE TAKING ,

ATTACHMENT F PARTS LIST FOR DECONTAMINATION AND SAMPLE O 12/80 TAKING KITS ATTACHMENT G REA STORED SUPPLIES AND EQUIPMENT 3 6/84 ATTACHMENT H RADIATION EMERGENCY TELEPHONE DIRECTORY 6 10/84, ATTACHMENT I LOCATION OF MANUALS 4 6/84 ATTACliMENT J PERSONNEL DOSIMETRY LOG AND PATIENT DATA 1 10/84 SHEETS l

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<o Revision: 3 June, 1984 DECONTAf11 NATION $ TREATMENT OF THE RADI0 ACTIVELY CONTAMINATED PATIENT AT SALEM COUNTY MEH0 RIAL HOSPITAL

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A. PURPOSE AND SUtWARY ,

1. Byfagreement between Public Service Electric & Gas Company and Salem County Hemorial Hospital, personnel at Salem Nuclear Generating Station sustaining injuries from ionizing radiation or injuries complicated by radiation exposure or radioactive contamination will be provided care and treatment at Salem County Memorial Hospital. .

'2. Most of these injury cases will present no hazard to hospital personnel and will be admitted and provided care and treatment in accordance with the hospital's operating procedures. However, in tEevent that an acci--

dent victim is radioactively contaminated, he will be admitted, decon-taminated and treated in accordance with these procedures.

3. The purpose of these procedures is to assure the radiation protection of the hospital staff, other patients and visitors during admission'and treatment of the radioactively contaminated patient. The hospital's

. protection p'tingram starts at the Salem Nuclear Generating Station with an alert or warning telephone call to the hospital 'with infonnation that there has been a radiation accident, and one or more injured and contami-nated persons may requi m treatment. On receipt of such a' call . .the

, staff will prepare to admit the patient (s) through the Radiation Emer-gency Area (REA). The REA will be set up in accordance with the directions

, given in Section E, " Procedure".

4. Hospital personnel will utilize protective clothing and personnel radiation

_ dosimeters in accordance with directions contained in Attachment 0, " Pro-cedure for the Use of Protective Clothing and Dosimeters". Decontamina-tion of the patient (s) as may be required, and the collection of contami-nation samples will follow the directions given in Attachment E.

B. PRECAUTIONS ,,

There are three major types of radiation exposure which may cause injury:

- 1) penetrating radiation exposure from a source external ~ to the body (ganna rays, neutrons):

A

2

, Revision: 3 June, 1984

, B. PRECAUTIONS (Continued)

2) internal exposure to radionuclides by ingestion, inhalation, absorption,

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or through a skin break; ,

3) sitin and superficial tissue exposure by ' contamination of'the surface of 4

the body with radfoactive materials, including subcutaneous radioactive foreign objects.

A patient who has been excessively exposed to external radiation will .not present a hazard to attending personnel. Radiationthathasinjuredapat[,entwillno more harm the attendant ~than heat that has injured a burn patient will harm the attendant. ..

A patient who has received an overdose of radionuclides by ingestion or inhala-tion is no more of a hazard than the patient who has been given diagnostic radioisotopes in a hospital nuclear medicine department.

An individual whose clothing, skin and/or wounds are contaminated with radio-
active material may present a radiation hazard to attending personnel in the absence of adequate procedures'to prevent the spread of the contamina,nt or control of the rjdiation exposure from the contamination. -

' Since radiation in uries are not immediately If fe-threatening, primary atten-tion should a1 ways be directed to traumatic life-threatening injuries, .e.g. ,

j. severe bleeding, airway obstruction, shock. Concomitantly, or as soon as possible, the patient should be decontaminated.

l C. PREREQUISITES

1. -Alert / Notification l- .

4 As soon as it has beren established by the Sales Nuclear Generating Station personnel that'a patient will be transported to the hospital for treatment, an alert call to this effect will be given. As soon as this has been estab-lished Salem Station personnel will notify the hospital, The alert and I

, notification calls will be directed to the Hospital Switchboard Operator, (609)935-1000, who, in turn, will notify the Nursing Supervisor.

t ._ . _ _ _ _ . . _ . -2 '

Revision: 3 June. 1984 C. PREREQUISITES (Continued)

2. prior Action at the Salem Nuclear Generating Station Before sending the patient (s) to the hospital, the Salem S,tation personnel will accomplish the following procedures: .
a. Administer first aid,
b. Notify ambulance.

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c. Call the hospital and inform them of expected arrival time, description of apparent in. furies and number of patients.
d. Decontaminate the ' patient (s) to an extent compatible with in. juries.
e. Assign station personnel qualified in radiation protectioii procedures to accompany the patient (s).

D. LIMITATIONS AND ACTIONS

1. Salem County Memorial Hospital is the only treatment fr.111ty where radio-actively contaminated accideist casualties from the Salein Nuclear.Ger:erating

, Station may be treated without explicit approval of the Medical

  • Director of Public Service Electric & Gas Company.

I 2. All decontamination of hospital personnel, equionent, and facilities shall

[ be supervised by Salem Nuclear Generating Station personnel.

[ E. ' PROCEDURE

1. Notification In accordance with C.I. Salem Nuclear Generating Staticn personnel will alert the hospital by calling the switchboard operator, who in turn calls one of the following persons in the order If sted, during normal hospital hours.

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a. Nursing Supervisor.
l. b. President,
f. c. Senior Vice President,
d. Vice President - Nursing.

> The initial notification call will be directed to the Nursing Superviso,r I

'on duty who will' obtain the'f511owing informationt

[i a. Date and time of call.

L v, b. Person calling:

L (1) Name.

i s

(2) Address I

L_.

(3) Telephone Number

Revision: 4 I October, 1984 E.. PROCEDURE (Continued) 7 The call wi11 then be transferred to E.R. personnel for, the following

. . information:

(1)'l Locat f on.

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(2[Dateandtime.

(3) Number of patients.

(4) Extent of injuries. '

(5) Contamination status. .

(6) Expected time of arrival.

  • After recording this information both parties should hang up and the Nursing Supervisor should redial the Senior Shift Supervisor at 339-3027 d; or 339-4343, the Shift Supervisor of Salem Unit I at 339-3016 or the

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Shift Supervisor of Salem Unit II at 339-3026. Verify the authenticity of the call with one of these people. If the call cannot be verified, no further action is required. If the call is' verified, proceed with the' Code Magenta Plan.

The hospital President will contact and instruct:

a. Switchboard Operator to declare Code Magenta * (during normal hours).
b. Nursing Supervisor (during off hours).

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c. Radiation Management Corporation, (215)"S3-2990 - 24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> emergency

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2. Nursing Supervisor's Duties +

Prior to Patient Arrival. '

On A. Complete. the top of the form seen under Attachment 8 (page B-1) of.

l+ . this manual.

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8. - Notify Emergency Room physician and nurses.

C. Report to Radiat10n Emergency Area and supervise preparation.

D. Assign nursing personnel to assist physician in treatment room.

[ E. Assign Control Point Attendant.

F.- . Assign Buffer Zone nurse. ,

Patient Arrival ,

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Supervise all actilities in treatment room and buffer zone,

  • Upon declaration of code Magenta, personnel associated with radiation medical emer-gencies will report to th(REA'and perfons their respective duties accordingly.

.+'.N0TE: Should Nursing Supervisor be involved in a code.. Emergency Room personnel will perform these duties.

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4 Revision: 3 June. 1984

E. PROCEDURE

(Continued)

3. Maintenance / Housekeeping Personnel's Duties Upon notification of Code Magenta, open and prepare Radiation Emergency Area as follows:
  • Prior to Patient Arrival Sten 1 l

Clear treatment room of non-stationary supplies and equipment.

Step 2 -

Obtain radiation emergency supplies from storage closet.

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Step 3 -

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

a. Yellow Herculite, to be placed as follows: *

(1) Ambulance Entrance (outside door and anteroom -- weibht this sec. tion) .

(2) Treatment Room.

(3) ,An t,emos. -

b. Green Irculite -- Buffer Zone. .
c. White Herculite -- use for patient exit only.

Step 4 Attach decontamination table top to gurney and place IS-gallon water receptacle under drain.

Place 32-ga11on lined waste receptacles in treatment room and buffer zone.

Step 5 Erect warning rope and signs across hallway and buffer zone.

Step 6 Attach hose with showerhead to faucet and adjust water temperature to luke warm.

Step 7

i. _. . Open Deicontamination and Sample Taking Xits on table in treatment room.

Step 8 L

If the possibility of ~two patients exists, move a second gurney to the area outside the REA until needed.

Revision: 3

. , June, 1984

E. PROCEDURE

(Continued)

4. Emergency Room Nursing Personnel's Outies*
  • In absence of Nursing Supervisor, perform duties listed under E.2.

Prior to Patient Arrival

'A. Don protective clothing and dosimeters in accordance with directions contained in Attachment 0 of this manual. .

8. Cociplete bottom section of form seen under Attachment 8 (page 8-1) of this manual. *
  • Patient Arrival A. Assist attending physician in patient stabilizatfor..
8. Collect bioassay samples in accordance with directions con:ained -

in Attachment E of this manual.

C. Assist in patient decontamination in accordance with directions

~contajhid t in Attachment E of this manual. *

  • D.. Assist in patient *:ransfer and exit procedures. -

1 E. Remove protective clothing and dosimeters in accordance with directions contained in Attachment D of this manual.

L F. Insure the ambulance remains in innedtate area until released by.

Salem Station radiation. protection personnel.

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Revision: 3 June, 1984

E. PROCEDURE

(Continued)

5. Attending Physician's Duties Prior to Patient Arrival ,

A. Assure that the Radiation Emergency Area is set up for admission of 2

a radioactively contaminated patient.

8. Assure that necessary medical supplies and equipment are brought to the REA. .

C. Don protective clothing and dosimeters in accordance with directions contained in Attachment 0 and Otagram III of t,his manual.

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Patient Arrival A. In the event of multiple patients, assure that appropriate treatment priority is assigned. If the patient is not critically frUured, he should remain in the ambulance and be adnitted according to triage

. method.

r B. Question the' accompanying Salem Nuclear Generating Station,' personnel concerning the patient's contamination status and precautions that should te taken by the hospital staff._ '

.. C . Administer emergency treatment.

D. Insure that requested medical supplies are passed into decontamination /

treatment room. 1 l E. -Decontaminate the patient and collect samples of the contaminant in accordance with Attachment E of this procedure.

. F. 'Following decontamination and emergency treatment, direct the transfer of the patient from the REA to the appropriate section of'the hospital l

for care or further treatment.

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L G. Remove protective clothing and dosimeters in accordance with directions i contained in Attachment D of this manual.

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l Revision: 3 3 June, 1984 1

E. PROCEDURE (Continued)

, 6. Control Point Attendant's' Duties Prine to Patient Arrival -

t A. Assure that .the personnel entering the REA are wearing protective clothing, self-reading pocket dosimeters, film badges and ring TLDs.

B. Don protective clothing and dosimeters in accordance with directions contained in Attachment 0 and Otagram III of this manual..

C. Restrict access 'to only those personnel authorized entry .by the attending physician or Nursing Supervisor.

D. Mairitain a record showing name, time and initial dosimeter reading of each person entering or exiting REA. (Refer to Attachment J).

E. Record serial numbers of dosimeters, film badges and TL0s,'as well ,

as person's name (see Attachment J. Personnel Dosimetry Lo,*g).

Patient Arrival

.A. Assure,that no, person or article is allowed to leave the REA (after the radioactively contaminated patient is admitted) until it has been monitored by Salem Nuclear Generating Station personnel and found to be " clean", i.e free of ' detectable radioactive contami-nation.

8.. Ifecord results of radiation surveys performed by plant radiation protection personnel on anatomical diagrams provided in the decon-tamination kits and Section J of this manual using a separate diagram for each survey for each ; stient.

C. Record dosimeter readings and collect dosimetry from all individuals exiting the REA.

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-Revision: 3 June, 1984 E. PROCEDURE'(Continued)

7. Buffer Zone Attendant's Outies .

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Prior to Patient Arrival ,

A. Obtain medical supplies as requested by attending physician.

B. Don protective clothing and dosimeters in accordance with directions contained in Attachment D and Diagram III of this manual.

Patient Arrival A.- Pass medical supplies inte treatment room as requested by attending physician. 00 NOT ENTER TREATMENT ROOM UNLESS SPECIFICALLY REQUESTED

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TO 00 50 BY ATTENDING PHYSICIAN.

8. Following emergency treatment and decontamination, prepare for removal of the patient from the REA. *

(1) Roll white Herculite from hallway (Clean Area, Diagr&m II) into Treatment Room.

(2) Weel in a " clean" stretcher across the white pathway'.to the

~_iddationimmediatelyadjacenttothepatient.

NOTE: It is important to remain on white Herculite while in REALto prevent cross-contamination.

(3)

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Assist in the transfer of the patient fmm the decontamination -

l' table top to the clean stretcher.

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. Revision: 2 Narch,1984 E. P_ROCEDURE (Continued)

8. . President's' Duties A. Upon notification from switchboard operator of imoending oatient arrival from Salem Nuclear Generating Station, reqLesi that '

Code Magenta be declared.

B. Assure that' a responsible hospital representative is availab'e to address any media concerns.

C. Assure that a representative from Public Service Electr',1c & Gas Company is available to address any media concerns. -

D. Provide additional support as required.

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i Revision: 3

' June, 1934

E. PROCEDURE

(Continued)

9. Plant Radiation Protection, Technician's (RPT) Duties Prior to Patient Arrival [

A radiation protection technician (RPT #1) from the Salem Nuclear Generating Statf'on will accompany the natient(s). in the ambulance and bring appropriate instrumentation. If staffing pennits, a second radiation protection technician (RPT #2) will arrive at the hospital in a separate vehicle and assist in the duties outlined below. ..

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Patient Arrival .. .

RPT #1-A. Provide advice and guidance to attending staff regarding radiation exposure and protective actions. *

8. Don protective clothing and dosimeters as provided by hospital staff.

C. Perfona frequent radiation surveys of patient and attendants.

D. Maintain contamination control to treatment area.

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E. Proyfqe advice and guidance to hospital staff regarding collection

,f of IA4fles and decontamination procedures in a'ccordance with directions contained in Attachment E of this manual.

[ F.. Decontaminate REA and equipment following patient and attendant exit.

RPT #2

, A. Survey ambulance and attendants prior to departure. If contamination f is found, ambulance should be returned to Salem Nuclear Generating Station for. decontamination.

B. Control patient and attendant exit procedures.

C.: . Perform radiation surveys of patient and attendants upon exit from the REA.

D. Collect dosimetry from personnel exiting the REA at tennination of emergency and return to Salem Nuclear Generating Station for processing.

E. Decontaminate REA and' equipment following, patient and_ attendant extt.

F. Maintain contamination control outside of treatment area.

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d Revision: 2 March, 1984 F. RETURN OF REA TO NORMAL USE Once 'the patient has been decontaminated, the REA and all equinment will be surveyed, decontaminated as required and released as soon a3 nossible by

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Salem Nuclear Generating Station radiation protection personnel.

'G. PATIENT TRANSFER TO. DEFINITIVE CARE CENTER

1. If it is determined by the attending physician, the Medical Director, Public Service Electric & Gas Company and Radiation Management Corpora-tion that the patient should be transferred to a defin'tive.' care center for the evaluation, diagnosis and long-term care of the radiation injury, this patient can be transferred to RMC's definitive care center located at the~ Hospital of the University of Pennsylvanif,in Philadelohia.

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2. Arrangements for transportation of the patient will be coordinated through Radiation Management Corporation (215) 243-2990 -- 24-hour emergency phone number. ,'

H. PROCEDURE FOR HANDLING MULTIPLE VICTIMS

1. Multiple.' injuries occurring at Salem Nuclear Generating Station would 'be managed tif~ utilizing the principles of. disaster planning. These include triage at all levels of care and primary attention to life-threatening
- injuries.' Radiation exposure and contamination should receive secondary l consideration. Up6n notification from Salem Nuclear Generating Station

~that there has been an accident involving more than one patient, complete the form seen under Attachment 8. Data Information Sheet. In addition,

' inquire as to the extent of ' medical assistance available on-site. The-Data Information Sheet should be given to the Emergency Room physician.

I i.

L 2. On-site medical-personnel with the assistance of ambulance' attendants should institute triage principles _with primary attention to life-threatening--

injuries. The most seriously injured should receive' priority evacuation.

Minimum decontamination should include the removal of contaminated clothing.

If time, availability of trans'ortation p and patients' med'ical condition

_- warrant, further decontamination (e.g., bathing with soap and water) can be accomplished. Each contaminated patient sent to the hospital should be u . ._ _ , . . _ _ -

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., Revision: 3

. June, 1984

-H. PROCEDURE FOR HANDLING itVLTIPLE VICTINS (Continued) accompanied by a trained radiation technician. Less seripusly injured victims should be completely decontaminated at the plant and be trans-ported to the hospital in a " clean" ambulance to the normal emergency room entrance.

3. Prior to patient (s) arrival, Salem County Memorial Hospital should initiate its Disaster Plan for handling muiciple casualties, at well as its procedure for handling contaminated and injured patients. The medical triage team should dress in protective clothing (see A't'tachment 0). The present REA and/or Emergency Room area shoirld be set up and ready to receive multiple contamination and injure [5tients.
4. Upon arrival of the. ambulance the triage team should have the most seri-ously injured and contaminated brought into the decontamination / treatment room. The less seriously injured should remain in the ambulance. A decontamination team should be assigned to begin decontamination in the

. ambulance. Contaminated c.lothing can be removed and collected an.d

.decontaminatpd_ areas caneb' wiped with a damp cloth. If decontamination cannot be comp 1eted the areas should be covered with ' plastic or cloth.

5. After the patter.ts have been treated and decontaminated, the REA should

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,. be closed off; Sales Nuclear Generating Station personnel.should survey ,

and decontaminate hospital supplies, equipment. adulances and the area 1 prior to releasing it for routine usage.

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  • MiBULNCE ACCESS RGDd Revision: 1 June, 1984 STAFF BATHROOM 7 SHOWE -

Z, AREA BgF.iR f' .

J MONITORING (COUROL) P0li l '

MONITORING l.- STATION ---- -- O g 4 . .

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MONITORING (COMROL) f POINT I

u RADIATION EfERGENCY AREA l (- s l -._3

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CONTAMINATED AREA MONITORING (CONTROL POINT _

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STORAGE AREA MLY >

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STORAGE R004 (MMA.ANCE PERSOffEL

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\ Emergency Room Radiation Emergency Entrance Area Entrance i

  • % Contaminated Medical Personnel Flow

_ %u Clean Medical Personnel Flow OIAGRAM

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' Revision: 2 March, 1984 O

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ee e ATTAClf1ENT A QUICK SORT PROCEDURE FOR HANDLING ANY RADIATION ACCIDENT VICTIM ,

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i* Revision: 3

", June. 1984

, ATTACHMENT A Procedure for Handling Any Radiation Accident Victim at the Emergency Room .

1.

Ascertain whether the patient is CONTAMINATED (Use Geiger flueller Tube)

A. . If so '... Admit 'the patient to REA Amoulance Entrance when set up as -

Radiation Dnergency Area (REA)

8. If not ... Admit to nomal Emergency Room C. If in doubt ... Admit patient to REA .$
2. Treat traur.atic injury. ..
3. If contaminated,' decontaminate in REA
4. _ Call for assistance

- Attending Staff. Emergency Room

. - Radiation Management Corporation (RMC):

Philadelphia (215) 243-2990 / (215) 841-5141 Chicago.. (312) 291-1030 .

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PROCEDURE FOR ADMISSION OF UNANNOUNCED ACCIDENT VICTIM (S)

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, sustair patient in ambulance . instruct driver, attandants, 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).

A-1

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Revision: 2 March, 1984 AT_T,ACHMENT A (Continued)

Patient Still in Ambulance (Continued)

Clean an area of about 8 feet around ambulance and keep unnecessary personnel and vehicles away. Attend to patient's medical condition as required. Use surgi-

cal gloves and mask. If imediate life-saving miasures are not necessary, observe

, , patient from a distance. All equipment and supplies used to attend to patient MUST stay in vicinity of the ambulance. M NOT carry anything back to the Emergency Room.

Imediately request assistance from Salem Nuclear Generating Station and Radiation Management Corporation. Then:

, - Request of Emergency Room staff that the Ambulance EMrance at the REA be set up as a Radiation Emergency Area; ..

- Clear every person out of REA before bringing patient in;

~ - Instruct driver to stay with ambulance until a radiation survey has been made; .

- Bring necessary equipment and supplies to treat patient from Emergency Room to REA. All equipment, supplies and personnel entering REK MUST stay there until arrival of radiation monitoring personnel. Esta5Tfsn a guard at the door. Pass Emergency Room supolies and equipment into REA; but g NOT allow personnel and equipment to come out; and

- Personnel attending patient in REA should stand next to patient only as long as ndtessary to _ perform _ life-saving measures. At all other times,' stand about five to eight feet back and observe natient;

- Only persons attending the patient should be in the room.

Radiation Status Discovered After Admission to Emergency Room

- Immediately secure the entire area through which the patient has passed i' or is located. Keep all oersonnel and equipment in the area. 00_ NOT allow anyone or anything to leave; l .- Establish a control point through which necessary personnel and equipment

j. . pass into restricted area;

- Make arrangements to admit other patients to uninvolved area of Emergency

Room through the outpatient entrance.

- Attend to patient's emergency medical condition as required. Use surgical gloves, mask and gown when treating patient. If feediate life-saving measures are not necessary, observe the patient from a distance (five to-

-eight feet). Immediately request assistance from Radiation Management Corporation or Salem Nuclear Generating Station (see Telephone Directory, Attachment I).

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. Revision: 3 June. 1984 e

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-ATTACHNENT B TELEPHONEPROCEDUREFORNURSINGSUPERVISO,Rl,'

ANO - -

EMERGENCY ROOM NURSE e

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' Revision: 3

',' June. 1984 ATTACHMENT B DATA INFOR!tATION SdEET The Nursing Supervisor should obtain the following information'from the caller:

Date and Time of Call: .

Person Callino: .

Name: .

Address: -

Telephone Number:

The Emergency Room Nurse will obtain the following: '

Accident:

Location:- ,

Date and fj1ne:

Number of Patients:

I' j

Extent of Injuries:

Contamination Status:-

[ _

Expected Time of Arrival:

  • 8-1

Revision: 2 Ma rch, 1984 O

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EMERGENC'Y TREATHENT OF RADIATION ACCIDENTS 9

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. June, 1984 ATTACHMENT C EMERGENCY TREATMENT OF RADIATION ACCIDENTS 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:

A. Resuscitation and Stabilization.

8. Initial Decontamination.
  • C. Evaluation of Radiation Status. ..

D. Initial Treatment of Radiation Injury. ,,',

- A. RESUSCITATION AND STABILIZATION

.Since radiation injury is not insnediately life-threatening, primary att,ention should always be directed to traumatic life-threatening injuries -- maintenance of airway, arrest of bleeding, treatment of shock and control of pain.

3. INITIAL DECONTAMINATION Concomitantly with-t'he procedure above, or as soon as possible, the patient should be decontaminated. In the-initial decontamination , . . . . .

Remove all clothing; Obtain sampir:s of contamination (. skin smears, tissue, fluids, etc.);

Survey with a Geiger Mueller monitor and note levels of contamination on Patient Radiatfog and Medical Status Record Sheet (see Attachment J);

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

wounds;_

-Repeat surveys and sangling as necessary; Flush wounds with copious amounts of sterile water and/or saline; Flush orifices with water or saline. - Do not allow patient to swallow; Stop with initial decontamination when activity levels are measured in the few thousand counts / minute;~

See Attachment E for detaf1s on decontamination and sample taking.

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Revision: 3

. June, 1984 ATTACHMENT C (Continued)

-C. 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 th'e patient wearing breathing apparatus? Was there surface contamination?" Any skin broken? Was source in contact with body? Was the patient wearing dosi-meters? ,','

Dose Evaluation:

This will require the assistance of persons knowledgeable in rad,iation.

This assistance can be by someone on location or by telephone. ,In any case, gather as much of the following inforination as possible: .

- Dose rate (gansna, x-ray, neutrons, etc.) as measured by instruments in accident environment;

- Radiart4en exposure reading on patients' and others' dosimetets (TLD, film badge, pencil dosimeter);

- Level of residual contamination (beta, gamma) on patient

using survey meter (mark areas on Patient Data Sheet --

see Attachment J);

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

- Calculation of ' dose to the patient and to attendants.

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  • Revision: 3 June, 1984 ATTACHMENT C (Continued)

Clinical picture: A good estimation of the severity of the patient's external, total body exposure can be obtained by observing the followino clinical symptoms and signs:

- Nausea and vomiting ... % 100R*

S.as .nning 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 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) -

- Ofarrhea ... >400R

- 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 /> ...

good prognosis 1200/mf 300-1200/m guarded prognosis 3

  • 300/m poor prognosis

D. INITIAL TREATifENT OF RADIATION INJURY Detailed Decontamination: It is particularly important at this stage to remove L high' level contamination caused by penetrating missiles or splinters in wounds.

Overexposure: Since overexposure to radiation results in a slowly unfolding course over a long period of time, there is little.in the way of specific treat--

! ment in the initial stage of the disease. Treatment is symptomatic and consists of making the patient comfortable and allaying his fears. He may require anti-metics, fluids, sedatives and 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 i

(10 cc sterile heparinized blood) for chromosome analysis. Keep sample chilled i

,in ice water.

' Internal Contamination: Except in a few instances, t'here is also if ttle to offer in the way of specific treatment in the initial stages.

i i .C-3

' nev is sues : 4 March, 1984 ATTACHMENT C (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 /> continuous 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 detemined that an appreciable amount of radioactivity hks been ingested (which is seldom the case), a stomach lavage, emetics (ZnSO 4 ) or cathar-r tics (10% MgSO ) may be _ indicated. [. -

4 If it has been detemined that the patient absorbed considerable amounts of......

Tritium (3 H) . . . . . . . . force fluids Radioiodine.........give Lugol's solution or other thyroid-61ocking agent imediately (reduces thyroid uptake of I-131 by 50% if given within 4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br /> post-exposure; pro-bably not effective after 12 hours1.388889e-4 days <br />0.00333 hours <br />1.984127e-5 weeks <br />4.566e-6 months <br />)

. PRINCIPLES OF RADIATION PROTECTION ,"

~

l 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 gloves;

- As few attendants as necessary should be in the same room with

-patient;

- Only in the performance of emergency treatment and initial _ decon-tamination should attendants be next to patients. At all other times, e.g., while evaluating the patient, attendants should stand at least five to eight feet from the patient and observe him from a distance if' radiation levels are excessively high;

- Rope: off and control the area in which the patient is being treated, ALL persons, equipment and supplies that enter this area MUST stay there until Radiation Emergency Teams arrive to assist in the moni-toring and decontamination of people and equipment; Suggested pemissible levels of attendant exposure in the course of treating a l ,.

l patient are:

TOTAL to SR . . . . . . . . . . routine treatment and decontamination L 80DY to 25R .......... emergency treatment'and decontamination l ' EXPO- to 100R . .... . . ... lifesaving treatment and decontamination

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Revision: 3 June, 1984 ATTACHMENT C (Continued)

Principles of Radiation Protection (Continued)

To estimate beta. exposure use disc shaped monitor handle covered with plastic glove and pass over body approximately 1 inch from surface. If the reading is SR/ hour, an estimate of attendant exposure would be SR; treatment should take one hour.

Experience shows that it is e;xtremely 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 exposures over SR should be on a vol,'untary basis.

INITIAL BI0 ASSAY SAMPLES ..

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

81oodi -

1) 10 cc .for radiobioassay;
2) 5 cc (sterile heparinized) for chromosomes; keep samples chilled, in a glass ofl ice; -
3) 10 cc oxytated for, hemogram and differential *
4) '10 cc for:

a) chemistries; b)' electrolytes Hair, nails, metals from neutmn-exposed patient; l -Urine:-

1) first urine; l 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 (note locations)..

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

L Revision: 0 December, 1980

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ATTACHtiENT 0

_ PROCEDURE FOR THE USE OF PROTECTIVE CLOTHING AND 00SIMETERS All work past the Ibnitoring (Control) point requires protective c16 thing, independent of the degree of contamination present on the patient or his clothing. Each person entering REA should don two surgical gowns, two set's of surgical gloves, and two vinyl aprons, mask, cap and shoe covers, as well as dosimetry. (See Diagram III for donning

. protective clothing and proper placement of attendant dosimetry). After gross decon-tamination is completed, the outer surgical gown, gloves and apron are removed. k'ound care and decontamination will then be attended to. l

Removal of Contaminated Protective Clothing ,,

Upon completion of their activities in the Radiation EmergencyJreatment Room personnel will proceed to the Monitoring (Control) Point between the Treatment Room and the Buffer Zone (Diagram III). . They will remove their protective clothing and personnel dosimeter in the following order: -

-(1) self-reading , dosimeters (read and recorded by Control Point Atte'ndant);

(2) headwear and mask; j (3) apron and gown (turning them inside-out);

l' -(4) footwear ai]d;p_ loves (. removed at Step-Off Pad). -

~~

J h Clearance Procedures l'

After having removed protective apparel, each person who occupied the Treatment Area will be monitored prior. to leaving the Buffer Zone. If no contamination is foun'd, personnel may proceed to the change area and put on their normal clothing.*

L *If contamination is found, personnel will remain in the' Buffer Zone, away from the normal exit. Salem Nuclear Generating Station personnel will direct them through

, a decontamination process utilizing the water supply, soap and water collection s

l' system available irl the treatment room. A final survey will be performed at the contro11 point prior to entering the clean part of the hospital.

' Use of Dosimeters .

Dosimeters will be supplied by the Monitoring (Control) Point Attendant to all per- _

sonnel entering the Radiation Emergency Area. -

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Revision: 0 December, 1980 ATTACHMENT D (Continued)

Use of Dosimeters (Continued)

Dosimeters are of three types:

1. Direct reading dosimeters (" pen dosimeters") to monitor exoosed dose on a continuing basis. These must be recharged to read "zero" before they are distributed to each attendee.
2. Badge dosimeters - to form a permanent record of exposure.
3. Ring dosimeters - to form a permanent record of finger exposure.

Dosimeters are to be worn in the followinq manner:

l. At the neck line, clipped under the protective clothing;
2. On the ring fingers of hands, under the gloves, with detecting element at palm surface. -

Upon leaving the Radiation Emergency Area 'the wearer shall surrender his dosimeter to the Control Point Attendant, who will record the reading and number of the pen dosimeter and retain the badge and ring dosimeters for later process'ing. The Control Point Attendant must assure that the records clearly show the serial number of each dosimeter and period of time worn by each individual who occupied the i- Radiation Emergency Area.

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12. SelfnReading Dosimeter (On 2nd Gown -

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ATTACHMENT E PROCEDURE FOR J

PATIENT DECONTAMINATION AND SAMPLE TAKING 3

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Revision: 3 f June, 1984 g ATTACMIENT E General These procedures cover the use of the Decontamination and Sample Takino Kits.

The kits provide all the necessary items for the decontamination of a radioactively contaminated patient and the collection of specimen's of this contamination.

Tae collection of specimens is a prerequisite for a thorough evaluation of the meoical and radiation status of the patient. It should be performed in con-junction with patient decontamination. -

Attachment F provides a parts list for each of the two kits. There is also a parts list in each kit. Following use, the lists should be consulted for replen-ishment. The intended use of several of the items is indicated on the parts list.

-j Patient Decontamination Procedures ~l

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W Principles The objectives of decontamination are: 9 9

1. to prevent injury caused by the presence of radioactive. substances 1 on the body; "

to prevent the spread of contamination over and into the patient: and 2.

3. to prevent attending personnel from becoming contaminated themselves d

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

Although decontamination should be started as soon as possible, primary attention 6 should be given to the alleviation of life-threatening conditions created by traumatic -

injury. >

j

-A Decontamination is essentially the physical removal of radioactive material- frem the skin, wounds, or body orifices. Most decontaminants contain detergents or other r chemical agents to facilitate this removal. Therefore, most decontaminants are ,

i suitable for decontamination of the intact skin only, a.id are not appropriate for wound cleansing or irrigation of body orifices.

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j Decontamination is performed in the following manner:

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1. . from the highest level of contamination to the lowest; }y
2. - starting with the simplest procedure (e.g. ,' soap and water) to more i complicated procedures; .

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3. - with due regard to contamination of wounds, body orifices, etc. (see M

, , -below for specific guidelines).

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. A Revis.f on: 3 June, 1984 ATTACHMENT E (Continued)-

Patient Decontamination Procedures -(Continued)

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

Decontamination Procedures

-In some cases ' decontamination may have been started before the patient arrives at Salem County Memorial Hospital. The extent of decontamination will be dependent

upon the injury or illness.

. 'A ; General Two general rules apply to the performance of decontamination: '

1. Check the effectiveness of the technique applied.by monitoring periodi.cally; and 2 .' Avoid the spread of radioactive materials fiom the area being decontaminated to areas of lesser contamination by covering the adjacent area.

Decontamination sequence should proceed as follows:

1. Wounds and adjacent skin-
2. Body orifices and aajacent skin;  !

L 3. High level intact skin;

!! 4. Low level skin areas.

B. Steps To Be Taken For Decentamination and Sample Taking

-t '1. . Judge whether the patient's medical condition requires immediate intervention; stabilize wound, if necessary, and redress for later L decontamination; e ~

y 2. Obtain a briefing frora Salem Nuclear Generating Station personnel as to the contamination status of the patient, the exposure of the

. patient, and as to the' specific measures to be .taken by attending personnel with regard to their protection;

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l Revision: 4 October, 1984 ATTACHMENT E (Continued)

Decontamination Procedures (Continued) -

B. ' Steps To Be Taken For Decontamination and Sample Taking (Continued)

, 3.. Remove all clothing and monitor the patient with the radiation survey instrument by scanning the entire body (holding the probe about 1/2 inch from the skin), and record the findings on the Patient Data Sheets;

4. Obtain patient samples in accordance with Procedures for, Sample Taking, which follow. ~ COLLECTION OF SAMPLES SHOULO BE- PERFORMED PRIOR TO' DECONTAMINATION;
5. . Perform a gross decontamination (see Decontamination of Skin and -

Body Orifices which follow);

6. Clean up room and remove outer garments from attendants;
7. Proceed with wound survey and decontamination (see Procedures for Decontamination of Wounds);

8 . .. Complete detailed decontamination of patient;

. 9. Transfer patient to " clean" area of hospital -(see Diagram IV). -

Waste material will be appropriately collected and returned to Salem Nuclear Generating Station for disposal. ,

C. Decontamination of Skin i

1. Take smear sample of area (see " Sample Taking Techniques and Indi-cations");
2. Protect adjacent area if indicated by covering with towels;
3. Cleanse skin area; wash thoroughly with Turco soap and te'pid water, using' either cotton balls, preop 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;

  • Assure-that the water being used to decontaminate'the patient is being.

collected in the proper radiological container.

4. Ifcontaminationpersists,repeatstep(3)once; 5.. If contamination still persists, try gentle application of clorox or hydrogen peroxide. . NOTE: Avoid any of these entering wound or body openings. Repeat a few times using new cotton balls; remove decontami-nants with water; monitor; record results; 6.- After complete decontamination, dry skin and.appy Nivea cream to abraded

- or injrred areas;

-7. . If residual contamination is present, consult with radiation specialists to decide whether further efforts are indicated; if it is decided to

- accept residual contamination, dry skin and apply colloidin, mark the _

area involved and record;

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Revision: 3 October, 1984 ATTACleiENT E (Contineed)

Decontamination Procedures (Continued) ,

8. Collect all materials used and place in separate labeled containers.

NOTE: In case of serious contamination around a wound, rapid removal of the bulk of radioactivity can be obtained by shaving. In case of

-serious contamination of hair or under nails, clip nails, remove hair and retain; scrub thoroughly and repeatedly with intemittent surveying.

D. Decontamination of Body Orifices -

1. Take samples of activity in nostrils, ear canals, and other orifices as indicated (see " Sample Taking Techniques and Indications");
2. Decontaminate area surrounding orifices;
3. Gently clean orifices using wetted swabs;
4. If nose swab trdicates significant radioactivity in nasal cavity, use nasal blows and nasal irrigation;

.5. Collect all materials used and label containers.

E. Decontamination of Wounds

1. Use aperature drape to isolate the contaminated wound; '
2. Survey and take samples of wound (see " Procedures for Sample Taking");
3. Decontaminate skin adjactnt to wound;
4. . Depending on surface and depth of wound, irrigate wound with sterile

' saline, dab with gauze pads soaked.in sterile saline to cleanse wound;

collect all materials used and' place in separate labeled, containers;
5. . Remove obviously necmtic and devitalized tissue surgically; keep all tissue specimens removed; y 6. Repeatedly minitor wound; record results on patient record sheet;-
7. If contamination persists, consult with RMC to detemine further course of action;~ '

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' 8. - If wound is clean, treat wound as necessary.

Procedures for Sample Taking l Principles

, ;The' objectives of collecting specimens from a radkactively contaminated patient =

are as'follows:

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1. . -To evaluate the' amount and composition of the radioactive contaminants

'on and in the body;-

2n - To obtain data with regard.to'the patient's exposure to external radiation;

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.- I Revision: 4 l October,1984 ATTACHMENT E (Continued) 1 l

. Procedures for Sample Taking (Continued) ,

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3. To supply infonnation on the biological injury inflicted by the radiation.

.To ' meet these objecti.ves, the following types of specimens are collected routinely:

1. Materials containing the external contaminant (swabs, smears, tissue samples, contaminated cleansing fluids, etc.);
2. Specimens containing internal contaminant (feces, urine, sputum, etc.);
3. In case of neutron irradiation .... materials in which neutron induced radio-

-activity may be present (gold rings, buttons, hair, nail clippings);

4. Hematologicalspecimens(wholebloodinheparinized,oxalated,anduncoated tubes; blood smears).

As the analysis of radioactive samples with regard to their composition is only possible in samples with a relatively high radioactivity, care should be taken to collect and store'these samples saparately from the usuelly bulky samples with rather law activity (such as cleansing fluids, drapes, towels, etc.).

A sample which is not identifiable as to its source (location, time taken) may be

. practically worthless; therefore, taks care to properly collect, store, and. mark all

. samples.

' Sample Taking Techniques and Indications External Contamination:

, Before decontamination, the following samples shall be obtained:

1. Skin Smears: use Nucon smear pads, moisten with a few drops of water, y and smear a skin area of about 100 cm2 (4" X 4"), if 'possible, by allowing sticky side of the. smear to adhere to gloves and rubbing the smear pad over the surface to be sampled; place smear on record paper, record location and time and area smeared, if other than 100 cm2 and l .. place in envelope. -Alternatively, tape may be used to remove contami-E .nants for later examination. .

-2. 'Take samples of nails, hair and collect metallic objects (rings,' watches, glasses, belt buckles, etc.).

3. Wound Samples: use either one of the following metho'ds:.

2- - for large wounds with visible blood or wound fluid -- obtain a few cc using an eye ' dropper or syringe; transfer to bottle and label;

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Lfor superficial wounds -- rub gently with cotton swabs; return to tube = and label;

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< g E Revision: 3 October,1984 ATTACHMENT E (Continued) i

- Sample Taking Techniques and Indications-(Continued)

External Contamination (Continued):

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

Internal Contamination:

1. Body Orifices: wet Q-tip with a few drops of water: swab, and store-in waterproof envelope and label. ~
2. In all cases where internal contamination is expected: collect urine and feces in containers supplied, and record time of voiding.

In all cases where'a total body exposure is expected:

~1. Obtain 10 cc of oxalated blood for complete blood count and differential;

2. Obtain 10 cc of sterile heparinized blood for chromosome analysis;
3. Obtain 10 cc blood for electrolytes and chemistries.

Record time these samples were taken.

NOTE: . Return bioassay samples to kit. With any specimens necessary to

= the emergency me:lical treatment of the patient which are obtained prior to completion of decontamination.and are to be processed in the hospital laboratory, be sure to clean the outside of the.

specimen container (. test tube, etc.) and have it. surveyed before handing it out to the buffer zone attendant.

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ATTACHMENT F PARTS. LIST FOR DECONTAMINATION AND SAMPLE TAKING KITS O

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-l Revision: 0

  • - Oecember, 1980 ATTACHMENT F l l

DECONTAMINATION KIT Ouantity  !

Skin Decontamination Absorbent Balls, extra large 1 box Sponge-holding forceps 1

-Plastic Seaker, large 2 Preop Sponges 6 Surgical Scrub brushes- 10 Wash Bottle (for localized contamination) 1 ,

'Decontaminants (Skin Only)

Turco decon soap, bottle (for first decon effort: 1 general)

Clorox, bottle (for second decon effort) 1

' Hydrogen Peroxide 22 (H 0 ), bottle * (for third decon 1 effort)

  • shelf life - three years-Wound Cleansing Gauze pads, sterile 50 Sterile Surgical Gloves, assorted sizes 8 pair Solution bowl, plastic 1 Syringe, 50 cc 1 Cotton-tipped applicators 100

/Aperature Dr' ape 1 Decontaminants (Wounds)

Saline Solution, normal *, sterile bottle 1-LBetadine Surgical; Scrub _ bottle 1 Treatment Agents

'Nivea cream,-jar- 1 Colloidin, bottle 1

  • shelf lif'e - -two to three years F-1

Revision: 0 December, 1980 ATTACHMENT F (Continued)

DECONTAMINATION KITS (Continued) -

Ouantity Miscellaneous Materials Prep Kit 1 Scissors, heavy duty 1 Patient Radiation and Medical Status Anatomical 12 Diagram Plastic bags, assorted sizes (to hold decon 8 materials after use)

Tissue paper, box 1 Notebook 1 Pencils 2 Finger-Nail Clippers 1 SAMLE TAKING' KIT ,

Sample Type Samplino Instrument Ouantity Nasal swabs 4 Aural swabs 4 Oral swabs 4 Skin Folds swabs 4 Swipes swabs 4 Swipes Nucon Smear 25 slots Hair small container 4-Nails small container 4' Metallic Objects. medium container / 2 small

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

Urine (24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br />) 2000 cc plastic container 1 Feces fecal container 2 Wound Exudate swabs 4 eyedropper & bottle 2 Tissue containers 2 small

~ 2 medium Vomitus fecal container 2 Irrigation fluids 100 ce plastic bottle 2

-F-2 ,

Revision: 0

' ^ December, 1980 ATTACHMENT F (Continued)

SAMPLE TAKING KIT (Continued)

Quantity Miscellaneous Items Envelopes ,

10

. Labels 50 Pens 1 grease I writing Scissors- 1 Tweezers 1

~ Clippers 1 3

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Revision: 2 March, 1984 ATTACHMENT G REA STORED SUPPLIES & EQUIPMENT e

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INVENTORY OF THE RADIATION EMKRCENCY MEDICAL SUPPLIES & EOUTPMENT Salem County Memorial Hospital Februsey 8, 1984 IIEE OUANTITY Decontamination kit, complete w/ 1 instructions E-Z Prep Hydrogen Peroxide Sodium Chloride Solution Betsdine Sample Taking Kit, complete w/ 1 instructions Decontamination Table Top complete 1 w/ splash guards and stretcher insert .

Barrel, 20 gal., mobile, white plastic 1 Barrel,'32 gal., w/ mobile base 3 Herculite, white, green, yellow sufficient Lead pig 1 Poster " Radiation Accident" 1 (1 framed)

Poster, CPR 1 Paper, brown kraft, co11 1 Rope, yellow / magenta sufficient

.Shleid, mobile, lead glass 1 1

Showerhead w/ hose-Sign, radiation warning w/ inserts 9 Sign, " Caution Radiation Area", metal. I Step-off pad 2 Tape, masking, 2" 2 s

Revision: 3

~ D.. ne, 1984 ITEM OUANT[TY INSTRUMENTS:

Charger, dosimeter - Johnson 1 Model CAT 6 S/N 24 Dosleeter..SRD 0-1 R 9

' Geiger Counter 1 .

Eberline Model E-520 S/N 3107

' Count. Rate Meter 2 each Eberline Model E-140N S/N 1090; S/N 1086 Constant Flow Air Sampler 1 .

RADECO Model HD 29A .

S/N 0582 ,

Glass Filter 47 mm sufficient Radiation Nonitor with NP210 Probe 1 RMC Type Eberline Nodel BM-14. 3/N 3999

.TLD. control 1 TLD.. badge 10 L TLO. ring 10 NOTE: Instruments maintained and calibrated by plant 30VIPMENT:

Air vent plugs 5 Ambu resuscitator -l-Bucket, mobile, stainless steel 1 IV Stand 1 Mayo Stand -

1 Oxygen resuscitator, wall-mounted 2 Resuscitator.. manual 1 ,

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ITEM OUANTITY Sphygmomanometer, well-mounted 2-

- Surgical lamp, ceiling-mounted 1 Waste receptacle, metal 1 Curney 1 Clock, weal-mounted 1 CLOTNING/ LINEN SUPPLIES Apron plastic, box 1 Cloves, surgeon's sufficient Protective Clothing Packs: (RMC type) 12 Aprons (2)

Cap '(1)

Gloves, surgeon's (2) pe Gowns (2)

Mask (1)

Shoe Covers, yellow (1) pr plastic MEDICAL SUPPLIES:

Specimen storage container 5 2

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Re ision: 4

, M . .-c h , 1984

'ATTACHMENF H RADIATION EMERGENCY TEl.EPHONE DIRECTORY e

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Revision: 6' October, 1934 -

ATTACHMENT H RADIATION EMERGENCY TELEPHONE DIRECTORY Salem County Memorial Hospital Day Night Emergency Room 609-935-1000 Ext. 231 J. Michael Galvin 609-925-1000 Ext. 201 609-299-0079 President Alberta Clour,'R.N. 609-935-1000 Ext. 255 609-935-6515 Vice President / Nursing or 379 Joanne Brodrick, R.N. 609-935-1000 Ext. 246 609-468-5496 In service Education

.Cdbrdinator-William L. Wilson 609-935-1000 Ext. 324 609-935-2047

. Director, Plant Operations

' Paul Fredricks 609-935-1000 Ext. 207 609-678-3654 Sr. Vice President Lawrence B. Owen, M.D. 609-935-1000. Ext. 326 609-678-3212 Chief of Staff

, Public Service Electric & Gas Company, 80 Park Place, Newark, NJ 07101 Bernard Reilly, M.D. 201-430-5930 201-744-2476 i

Medical Director Ronald J. Mack, M.D. 201-430-5939 201-773-9235 Manager of Dispensaries Assistant Medical. Director Coordinating Physicians John R. Castiglioni, D.O. 609-935-1000 Ext. 231 609-769-3152 4

Gordon J. Ostrum, M.D. 609-769.-0226 609-769-0460 l Lawrence. 8.: Owen . 609-935-1000 Ext. 326 609-769-3212

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. Chief. of Staff John Madara, M.D. 609-935-1477 609-935-2220 L 31 Market Street Salem, NJ 08079-

. Harry W e Fullertgn,Jrl,M.D. 609-299-0345 609-299-4910 i

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Revision: 4.

  • March, 1984 ATTACHMENTH(Continued)

RADIATION EMERGENCY TELEPHONE DIRECTORY (Continued)

Ambulance Service Day Night Lower Alloways Creek Ambulance 609-935-4222 (General Bus.) 609-935-4505 (Emer. #)

Elsinboro Fire & Rescue 609-935-2814 609-935-2814 N6rman Davis, EMT Coordinator 609-935-1000 Ext. 304 609-769-0818 Woodstown Ambulance / Rescue Salem Nuclear Generating Station John Zupko 609-935-6000 Ext. 4300

. Plant Manager Jim O' Con: or 609-935-6000 Ext. 4645 Radiation Protection Engineer Paul Eldreth 609-935-6000 Ext. 4572 Nuclear Fire & Safety En91neer Pete Moeller 609-935-6000 Ext. 4400 609-468-4737

'. Manager, Site Protection .

Wayne L. Britz ' 609-935-6000 Ext. 4546 609-935-4334-Manager, Radiation Protection Services Radiation Management Cot 9 oration Emergency: PRIMARY 215-243-2990 SECONDARY' 215-841-5141 GENERAL BUSINESS 215-243-2950(Philadelphia) 312-291-1030 (Chicago)

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Revision: :3 March, 1984 g

ATTACHMENT I LOCATION OF MANUALS 9

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RLvision: '4

.. June, 1984 ATTACHMENT I LOCATION OF MANUALS ,

Manual Number Location Radiation Management Corporation 1 Philadelphia Office Salem Nuclear Generating Station 2mA Manager, Radiation Protection Services 3NW EOF Locker 4 i . oc.- Radiation Protection Engineer 55 Nuclear Department, Safety Supervisor

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7 Security Emergency Locker Salem County Memorial Hospit-1 8 Fresident

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9 Senior Vice President .

10 Radiation Emergency Area .

11 Vice President / Nursing 12 Nursing Supervisor 13 In service Education Coordinator 14 Chief of Staff 17 Radiology 18 Plant Operations Director Coordinating Physicians 15 GordonJ} Ostrum,M.D.

Public Service Electric & Gas Company 16' Medical Director O

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December, 1982 ATTACHMENT J PERSONNEL 00SIMETRY LOG AND PATIENT DATA SHEETS e

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