ML20133P237

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Rev 8 to Emergency Plan Procedure M1-7, Decontamination & Treatment of Radioactively Contaminated Patient at Salem County Memorial Hosp
ML20133P237
Person / Time
Site: Hope Creek PSEG icon.png
Issue date: 08/09/1985
From: Linnemann R
Public Service Enterprise Group
To:
Shared Package
ML20133P226 List:
References
M1-7, NUDOCS 8508140223
Download: ML20133P237 (64)
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Procedure No. M1-7

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DECONTAMINATION AND TREATMENT ,

OF

~i THE RADI0 ACTIVELY CONTAMINATED PATIENT AT ,-

SALEM COUNTY MEMORIAL HOSPITAL

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CAD Approved by

,hy $ # l-Roger E'.l.innemann, M.D.

Vice Chairman O ..

8508140223 850809 PDR F

ADOCK 05000354 PDR

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I Procedure No. M1-7 Revision 8 (June, 1985)

REVISIONS PAGE i SALEM COUNTY MEMORIAL HOSPITAL Rev. No. Date

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1 10/82 2 3/84 3 6/84 4 6/84 5 6/84 6 10/84 7 5/85 (Complete, Manual) 8 6/85 e

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  • Procedure No. M1-7 Revision 7, (May, 1985)

DECONTAMINATION AND TREATMENT OF THE RADIOACTIVELY CONTAMINATED PATIENT AT SALEM COUNTY MEMORIAL HOSPITAL TABLE OF CONTENTS TITLE PACE NO. REV/DATE A. PURPOSE AND

SUMMARY

1 7 5/85

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B. PRECAUTIONS 2 7 5/85 C. PREREQUISITES ,

1. Alert / Notification 2 7 5/85
2. Prior Action at Salem Nuclear Generating 3 7 5/85 Station / Hope Creek Generating Station ,

g D. LIMITATIONS AND ACTIONS 3 7 5/85 O ,

E. PROCEDURE

. 1. Notification 3 8 6/85

2. Nursing Supervisor's Duties 5 7 5/85
3. Maintenance / Housekeeping Personnel's Duties 6 8 6/85
4. Emergency Room Nursing Personnel's Duties 8 7 5/85
5. Attending Physician's Duties 9 7 5/85
6. Control Point Attendant's Duties 10 7 5/85
7. Buffer Zone Attendant's Duties 11 7 5/85
8. President's Duties 12 7 5/85
9. Plant Radiation Protection Technician's (RPT) 13 7 5/85 Duties F. RETURN OF REA TO NORMAL USE 15 7 5/85 C. PATIENT TRANSFER TO DEFINITIVE CARE CENTER 15 7 5/85 N. PROCEDURE FOR HANDLING MULTIPLE VICTIMS 15 7 5/85 O -

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(,,,/ Procedure No. M1-7 Revision 7, (May, 1985) l TABLE OF CONTENTS (Continued)

REV/DATE DIAGRAM I Plan View of REA 7 5/85 DIAGRAM II Attendant Garb 7 5/85 DIAGRAM III Floor Covering for Patient Transfer 7 5/85 ATTACHMENT A Admission Procedure for Radiation 7 5/85 Accident Victims ATTACHMENT B Telephone Procedure for Radiation Accident 8 6/85 Emergencies: Nursing Supervisor and

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Emergency Room Nurse ATTACHMENT C Emergency Treatment of Radiation Accident 7 5/85 ATTACHMENT D Procedure for the Use of Protective 7 5/85 Clothing and Dosimeters ATTACHMENT E Procedure for Patient Decontamination and- 7 5/85 Sample-Taking ATTACRMENT F Parts List for Decontaminetion and Sample- 7 5/85 Taking Kits ATTACHMENT C REA-Stored Supplies and Equipment 7 5/85 ATTACHMENT H Radiation Emerge'ncy Telephone Directory 8 6/85 ATTACHMENT I Location of Manuals 8 6/85 ATTACHMENT J Personnel Dosimetry Los & Patient Data 7 5/85 Sheet O -

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Procedure No. M1-7 Revision 7. (May, 1985)

DECONTAMINATION & TREATMENT OF THE RADIOACTIVELY CONTAMINATED PATIENT AT SALEM COUNTY MEMORIAL HOSPITAL A. PURPOSE AND

SUMMARY

< 1. By agreement between Public Service Electric & Cas and Salem County .

l Memorial Hospital, personnel at Salem Nuclear Generating Station / Hope Creek 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 our standard operating procedures. However, in the event that an accident victim is radioactively contaminated, he will l be admitted, decontaminated and treated in accordance with these procedures.
3. The purpose of these procedures is to assure the protection of the ,

hospital staff, other patients and visitors during admission and O treatment of the radioactively contaminated patient. The hospital's protection program starts at Salem Nuclear Generating Station / Hope Creek Generating Station with an alert or warning telephone call to the hospit'al with information that there tas been a radiation ,

> accident, and one or more injured and contaminated persons may require treatment. On receipt of such a call, the staff will

prepare to admit the patient (s) through the Radiation Emergency Area l (REA). The REA will be set up'in accordance with the directions given in Section E. " Procedure".

I' 4 Hospital personnel will utilize protective clothing and personnel radiation dosimeters in accordance with directions contained in Attachment D. " Procedure for the Use of Protective Clothing and Dosimeters". Decontamination of the patient (s) as may be required, l! and the collection of contamination samples will follow the directions given in Attachment E.

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k~ l Procedure No. M1-7 Revision 7, (May, 1985)

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 (samma rays, neutrons);
2. internal exposure to radionuclides by ingestion, inhalation, absorption, or through a skin break;
3. skin and superficial tissue exposure by contamination of the surface of the body with radioactive materials, including subcutaneous radioactive foreign objects.

A patient who has been excessively exposed to external radiation will not present a hazard to attending personnel. Radiation that has injured a patient will no more harm the attendant than heat that has injured a buen patient will harm the attendant.

A patient who has received an overdose of radionuclides by ingestion or inha'.ation is no more of a hazard than the patient who has been given

/'"'i diagnostic radioisotopes in a hospital nuclear medicine department.

V An individual whose clothing, skin and/or wounds are contaminated with radioactive material may present a radiation hazard to attending

, personnel in the absence of adequate proceduces to prevent the spread of l the contaminant or control of the radiation exposure from the contamination.

Since radiation injuries are not immediately life-threatening, primary attention should always be directed to traumatic life-threatening injuries, e.g., severe bleeding, airway obstruction, shcek.

Concomitantly, or as soon as possible, the patient should be decontaminated.

C. PREREQUISITES

1. Aleet/ Notification As soon as it has been established by the Salem Nuclear Generating Station / Hope Creek Generating Station 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 established, nuclear station personnel will notify the hospital. The alect and notifica-s

\+ / Proceduce No. M1-7 Revision 7, (May, 1985)

C. PREREOUISITES (Continued) tion calls will be die'ected to the Hospital Switchboard Operator, (609) 935-1000, who in turn, will notify the Nursing Supervisor.

2. Peloe Action At Salem Nuclear Generating Station / Nope Creek Generating Station s Before sending the patient (s) to the hospital, the nuclear station

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personnel will accomplish the following proceduras:

a. Administer flest aid.
b. Notify ambulance.
c. Call the hospital and inform them of expected arrival time, d.escription of apparent injuries and number of patients.
d. Decontaminate the patient (s) to an extent compatible with injuries.
e. Assign station personnel qualified in radiation protection procedures to accompany the patient (s).

D. LIMITATIONS AND ACTIONS'

l. Salem County Memorial Hospital is the primary treatment facility where radioactively contaminated accident casualties from the Salem Nuclear Generating Station / Hope Creek Generating Station may be

, treated without explicit approval of the Medical Director of Public ,

Service Electric & Gas Company.

2. All decontamination of hospital personnel, equipment and facilities ,

shall be supervised by Salem Nuclear Generating Station / Hope Creek

Generating Station personnel.

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E. PROCEDURE

1. Notification In accordance with paragraph C.1, Salem Nuclear Generating ,

Station / Hope Creek Generating Station personnel will aleet the i hospital by calling the Switchboard Operator, who in turn calls one of the following persons in the order listed, ducing normal hospital hours.

a. Nursing Supeevisor.
b. President.
c. Senior Vice President.
d. Vice President - Nursing.

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'- Procedure No. M1-7 Revision 8 (June, 1985)

E. PROCEDURE (Continued)

1. Notification (Continued)

The initial notification call will be directed to the Nursing Supervisor on duty who will obtain the following information:

a. Date and time of call.
b. Person calling.

(1) Name.

, (2) Address. . g (3) Telephone Number.

The call will then be transferred to E.R. personnel for the following information:

(1) Location.

(2) Date and time.

(3) Number of patients.

(4) Extent of injuries.

(5) Contamination status.

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(6) Expected time of arrival.

. After recording this information both parties should hang up and the Nursing Supervisor then redial the Salem Senior Shift Supervisor at 339-4027 or the Hope Creek Senior Shift Supervisor at 339-3669 or the Salem Shift Supervisor, Unit 1 at 339-3016 or the Salem Shift Supervisor, Unit 2 at 339-3026 or the Hope Creek Shift Supervisor at 339-3059. Verify the authenticity of the call with one of these people. If the call is verified, proceed with the Code Magenta Plan. If not, disregard the call and do not activate the plan.

The Nursing Supervisor will contact and instruct:

(a) Switchboard Operator to declare Code Magenta * (during normal hours).

(b) Radiation Management Corporation, (215) 243-2990 - 24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> emergency phone number.

(c) Contact hospital President or designee.

  • Upon declaration of Code Magenta, personnel associated with radiation 4

medical emergencies will report to the REA and perform their respective dutles accordingly.

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2 N s/ Procedure No. M1-7 Revision 7, (May, 1985)

E. PROCEDURE (Continued)

2. Nursing Supervisor's Duties +

Pelor to Patient Arrival A. Complete the top of'the form seen under Attachment B (page B-1) ,

of this manual.

B. Notify Emergency Room physician and nurses.

C. Report to Radiation Emergency Area and supervise preparation.

D. Assign Nursing Personnel to assist physician in treatment room, r,*

E. Assign Control Point Att.ndant.

F. Assign Buffer Zone nurse.

Patient Arrival Supervise all activities in treatment room and buffer zone.

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

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- Procedure No. M1-7 Revision 8 (June,'1985)

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

Clear treatment room of non-stationary supplies and equipment.

Step 2 j Obtain radiation emergency supplies from storage'cfoset.

Step 3 l

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

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a. Yellow Herculite, to be placed as follows:

. (1) Ambulance Entrance (outside door and anteroom -- secure this section).

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, (2) Treatment Room.

(3) Anteroom.

b. Green Herculite -- Buffer Zone.
c. White Herculite -- use for pat.ient exit only.

f Step 4

( Attach decontamination table top to gurney and place 15-gallon water

receptacle under drain.

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

Step 5 1

Erect warning rope and signs across hallway and buffer zone.

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O Procedure No. M1-7 Revision 7. (May, 1985)

E. PROCEDURE (Continued)

3. Maintenance / Housekeeping Personnel's Duties (Cont.)

Step 6 Attach hose with showerhead to faucet and adjust water temperature ,

to luke warm. .

Step 7 Open Decontamination and Sample Taking Kits on table in treatment room.

+ Sten 8 If the possibility of two patients exists, move a second gurney to the area outside the REA until needed.

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Procedure No. ML-7 Revision 7,(May, 1985)

E. PROCEDURE

(Continued)

4. Emerzency Room Nursinz Personnel's Duties *
  • In absence of Nuesing Supeevisor, perform duties listed under E.2.

Pelor to Patient Arrival

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

B. Complete bottom section of form seen under Attachment B (page B-1) of this manual.

Patient Arrival A. Assist attending physician in patient stabilization B.

  • Collect bioassay samples in accordance with directions contained in Attachment E of this manual.

C. Assist in patient decontamination in accordance with directions contained in Attachment E of this manual. .

D. Assist in patient transfer and exit procedures.

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

F. Insure the ambulance remains in immediate area until released by nuclear station radiation protection personnel.

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i Procedure No. M1-7 Revision 7 (May, 1985)

E. PROCEDURE

(Continued)

5. Attending Physician's Duties Pelor to Patient Arrival A. Assure that the Radiation Emergency Area is set up for ,

admission of a radioactively contaminated patient.

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

C. Don protective clothing and'datimeters in accordance with directions contained in Attac.. ment D and Diagram II of this manual.

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

Question the accompanying Salem Nuclear Generating Station / Hope B.

Creek Generating Station personnel concerning the patient's ,

contamination status and precautions that should be taken by the hospital staff.

C. Administee emergency treatment.

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

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 for care or further treatment.

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

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Procedure No. F1-7 Revision 7, (May, 1985)

E. PROCEDURE

(Continued)

6. Control Point Attendant's Duties Prior to Patient Arrival 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 D and Diagram II of this manual.

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

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

l O E. Record serial numb 9rs of dosimeters, film badges and TLDs, as well as person's name (see Attachment J _ Personnel Dosimetry Log). .

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 / Hope Creek Generating Station personnel and found to be

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

B.' Record results of radiation surveys performed by plant radiation protectir,n personnel on anatomical diagrams provided in the decontamination kits and Section J of this manual using a separate diagram for each survey for each patient.

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

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Procedure No. M1-7 Revision 7, (May, 1985)

E. PROCEDURE (Continued)

7. Buffer Zone Attendant's Duties 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 II of this manual.

Patient Arrival A. Pass medical supplies into treatment room as requested by attending physician. DO NOT ENTER TREATMENT ROOM UNLESS SPECIFICALLY REQUESTED TO DO SO BY ATTENDING PHYSICIAN.

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

s (1) Roll white Herculite from hallway (Clean Area Diagram N III) into Treatment Room.

(2) Wheel in a " clean" stretcher across the white pathway to the location immediately adjacent to the patient. ,

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

(3) Assist in the transfer of the patient from the decontami-i nation table top to the clean stretcher.

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  • Procedure No. M1-7 Revision 7, (May, 1985)

E. PROCEDURE

(Continued)

8. President's Duties A. Upon notification from switchboard operator of impending patient arrival from Salem Nuclear Generating Station / Hope Creek Generating Station, request that Code Magenta be declared. , j l

B. Assure that a responsible hospital representative is availa- l ble to address any media concerns. 1 C. Assure that a representative from Public Service Electric & Gas Company is available to address any media concerns.

D. Provide additional support as required.

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%2 Procedure No. M1-7 Revision 7, (May, 1985)

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 Station / Hope Creek Generating Station will accompany the patient (s) in the ambulance and bring appropriate instrumentation.

If staffing permits, a second radiation protection technician (RPT

  1. 2) will arrive at the hospital in a separate vehicle and assist in the duties outlined below.

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

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

C. Perform frequent radiation surveys of patient and attendants.

D. Maintain contamination control to treatment area. .

E. Provide advice and guidance to hospital staff regarding

.- collection of samples and decontamination procedures in accordance with directions contained in Attachment E of this manual.

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

RPT R2 A. Survey ambulance and attendants prior to departure. If contamination is found, ambulance should be returned to Salem Nuclear Generating Station / Hope Creek Generating Station for decontamination.

B. Control patient and attendant exit procedures.

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

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Procedure No. M1-7 Revision 7. (May, 1985)

E. PROCEDURE (Continued)

9. Plant Radiation Protection Technician's (RPT) Duties (Cont.)

RPT e2 (Cont.)

D. Collect dosimetry from personnel exiting the REA at termination ,

i of emergency and return to Salen Nuclear Generating Station / Hope Creek Generating Station for processing.

E. Decontaminate REA and equipment following patient and attendant exit. .

Maintain contamination control outside of treatment area.

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Procedure No. M1-7 Revision 7, (May, 1985)

F. RETURN OF REA TO NORMAL USE Once the patient has been decontaminated, the REA and all equipment will be surveyed, decontaminated as required and released as soon as possible by Sales Nuclear Generating Station / Hope Crook Generating Station I radiation protection personnel.

G. PATIENT TRANSFER TO DEFINITIVE CARE CENTER

If it is determined by the attending physician, the Medical 1.

Director Pubile Service Electric & Cas Company and Radiation i Management Corporation that the patienL should be transferred to a I definitive care center for the evaluation, diagnosis and long-term l

care of the radiation injury, this patient can be transferred to RMC's definitive care center located at the Hospital of the University of Pennsylvania in Philadelphia.

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

H. PROCEDURE

FOR HANDLING MULTIPLE VICTIMS

1. Multiple injuries occurring at Salen Nuclear Generating Station / Hope Creek Generating Station would be managed by 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 secondsey I consideration. Upon notification from Salem Nuclear Generating ,

Station / Hope Creek 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 shorld be given to the Emergency Room Physician.

2. On-site medical personnel with the assistance of ambulance attendants should institute telage 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 transportation and patients.' medical condition warrant,' further decontamination (e.g., bathing with soap and water) can be accomplished. Each contaminated patient sent to the hospital should be accompanied by a trained radiation technician, Less seriously in-1

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  • Procedure No. M1-7 Revision 7 (May, 1985)

H. PROCEDURE FOR HANDLING MULTIPLE VICTIMS (Continued) jured victims should be completely decontaminated at the plant and be transported 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 multiple casualties, as well -

as its procedure for handling contaminated and injured patients.

... The medical triage team should dress in protective clothing (see Attachment D). The present REA and/or Emergency Room area should be set up and ready to receive multiple contaminated and injured patients.

4. Upon arrival of the ambulance the triage team should have the most seriously 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 clothing can be removed and collected and decontaminated areas can be wiped with a damp cloth. If decontamination cannot be completed, the areas should be covered with plastic or cloth.

5. After the patients have been treated and decontaminated, the REA should be closed off; Salem Nuclear Generating Station / Hope Creek

. Generating Station personnel should survey and decontaminate .

e hospital supplies, equipment, ambulances and the area prior to releasing it for routine usage.

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SALEM COUNTY MEMORIAL HOSPITAL RADIATION EMERGENCY AREA (REA)

O ne n7 iMay 1985 BUFFER ZONE Nx\

Nk SHOWER AREA (CLEAN AREA)

MONITORING STATION @/ _\

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TREATMENT /

(CLEAN AREA)

DECONTAMINATION ~

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MONITORING POINT

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SUPPLY & AMBULANCE STORAGE PERSONNEL ROOM HOLDING AREA 4

/ N O AMBULANCE RECEPTION AREA ER ENTRANCE DI AGRAM _I

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Procedure No. M1-7 Revision 7, (May, 1985)

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ATTACNMENT A ADMISSION PROCEDURE FOR RADIATION ACCIDENT VICTINS 9

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Procedure No. M1-7 Revision 7, (May, 1985)

ATTACHMENT A Quick SORT Procedure for Handling Any Radiation Accident Victim at the Emergency Room Unioading Dock

1. Ascertain whether the patient is CONTAMINATED (Use GM Tube) ,

A. If so ... Admit the patient to REA Ambulance Entrance when set up as Radiation Emergency Area (REA).

B. If not ... Admit to normal Emergency Room.

C. If in doubt ... Admit patient to REA.

2. Treat trauma'ic t injury.

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3. If contaminated, decontaminate in REA.

l 4 Call for assistance.  !

- Attending Staff. Emergency Room. ,

- Radiation Management Corporation (RMC):

Philadelphia (215) 243-2990 / (215) 841-5141 ,

Chicago (312) 310-8650 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 accideat patient" has been determined.

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Proceduce No. M1-7

(' Revision 7, (May, 1985)

ATTACHMENT A (Continued)

Patient Still in Ambulance Clese an area of about 8 feet around ambulance and keep unnecessary personnel and vehicles away. Attend to patient's medical condition as requiced. Use surgical gloves and mask. If immediate life-saving measures ,

are not necessary, observe patient from a distance. All equipment and supplies used to attend to patient MUST stay in vicinity of the ambulance. DO NOT carry anything back to the Emergency Room. Then:

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

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

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

- Being necessary equipment and supplies to treat patient from Emergency Room to REA. All equipment, supplies and personnel entering REA MUST stay there until arrival of radiation monitoring personnel. Establish

[ T a guard at the door. Pass Emergency Room supplies and equipment into

(-- REA; but DO NOT allow personnel and equipment to come out;

- Personnel attending patient in REA should stand next to patient only ,

as long as necessary to perform life-saving measures. At all other timos, stand about five to eight feet back and observe patient; and

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

Radiation Status Discovered After Admission to Emergency Room

- Immediately secure the entlee area through which the patient has passed or is located. Keep all personnel and equipment in the area.

DO NOT allow anyone or anything to leave.

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i f Procedure No, M1-7 Revision 7, (May, 1985)

ATTACHMENT A (Continued)

Radiation Status Discovered After Admission to Emergency Room (Continued)

- Establish a control point through which necessary personnel and equipment pass into resteleted area;

- Make arrangements to admit other patients to uninvolved area 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 immediate 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 /

Hope Creek Generating Station (see Telephone Directory Attachment I).

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. i Proceduce No. M1-7 Revision 7, (May, 1985) n O

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ATTACHMENT B TELEPHONE PROCEDURE FOR NURSING SUPERVISOR AND

, EMERCENCY ROOM NURSE t

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. Procedure No. M1-7

() Revision 8 (June, 1985)

ATTACHMENT B DATA INFORMATION SHEET The Nursing Supervisor should obtain the following information from the caller:

Date and Time of Call:

Person Calling:

Name of Caller:

Telephone Number: ,

verify Call: The initial notification call will be directed to the Nursing Supervisor on duty who will obtain the following information:

Date and Time of Call:

Person Calling;

, Name:

Address:

- Telephone Number:

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. The Emergency Room Nurse will obtain the following:

Accident:

Location:

Date and Time:

Number of Patients:

Extent of Injuries:

Contamination Status:

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Expected Time of Arrival:

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Procedure No. M1-7 Revision 7 (May, 1985)

ATTACHMENT C EMERGENCY TREATMENT OF RADIATION ACCIDENTS e

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Procedure No. M1-7

  • Revision 7, (May, 1985)

ATTACHMENT C EMERGENCY TREATMENT OF RADIATION ACCIDENTS GENERAL

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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 I A. RESUSCITATION AND STABILIZATION I

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

B. INITIAL DECONTAMINATION l

Concomitantly with the procedure above, or as soon as possible, the ,

patient should be decontaminated. In the initial decontamination ......

- Remove all clothing; 1

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

- Survey with a Geiger Mueller monitor and note levels of contami-nation on Patient Radiation and Medical Status Record Sheet (see Attachment J); -

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

- Repeat surveying and sampling as necessary;

- Flush wounds with copious amounts of sterile water and/or saline; C-1 O -

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's / Procedure No. M1-7 Revision 7, (May, 1985)

ATTACHMENT C (Continued)

DECONTAMINATION (Continued)

- 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 details on decontamination and sample taking. -

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 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;

- Radiation exposure reading on patient's and others' dost-meters (TLD, film badge, direct reading doslmeter);

- Level of residual contaminant (beta, gamma) on patient using survey meter (mark area on Patient Data Sheets -- see Attach'-

ment J);

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

- Calculation of dose to the patient and to attendants.

C-2 4

n

\s_/

Procedure No. M1-7 Revision 7, (May, 1985)

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 following clinical symp-tons and signs: (R = Rems, air exposure)

- Nausea and vomiting ... % 100R ,

Beginning within 2 hours2.314815e-5 days <br />5.555556e-4 hours <br />3.306878e-6 weeks <br />7.61e-7 months <br /> - >400R

<200R Beginning after 4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br /> -

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

< 15R

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

- Diare,hea ... >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 /> ...

l 1200/mm3 good prognosis  !

I guarded prognosis n, _

300-1200/mm3 300/mm3 poor prognosis D. INITIAL TREATMENT OF RADIATION INJURY Detailed Decontamination: It is particularly important at this stage to remove high level contamination caused by penetrating misslies 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 treatment in the initial stage of the disease. Treatment is symptomatic and consists of making the patient comfortable and allaying his fears. He may require antiemetics, 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 (10 ce sterile heparinized blood) for chromosome analysis. Keep sample chilled in 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. Generally, specific treatment to eliminate any absorbed radioactivity requires rather detailed and complex analyses of 24-hour 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.

C-3 9

\ Procedure No. M1-7 Revision 7, (May, 1985)

ATTACHMENT C (Continued)

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

Teitium (3H) ..... force fluids.

Radiolodine ..... give Lugol's solution or other thyroid-blocking agent immediately (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; probably not effective after 12 hours1.388889e-4 days <br />0.00333 hours <br />1.984127e-5 weeks <br />4.566e-6 months <br />).

E. P9INCIPLES OF RADIATION PROTECTION Certain precautions to minimize exposure to attendants are necessary when dealing with a patient who has external contamination, specifically:

- Always wear two sets of disposable gowns, plastic aprons, shoe covers;

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

- Only in the performance of emergency treatment and initial decontamina-tion 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;

- Rope off and control the area in which the patient is being treated.

ALL persons, equipment and supplies that enter this area NUST stay there until Radiation Emergency Teams arrive to assist in the moni-toring and decontamination of people and equipment;

- 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 75R .... lifesaving treatment and decontamination C-4

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O .

Procedure No. M1-7 Revision 7 (May, 1985)

ATTACHMENT C (Continued)

To estimate attendant exposure, pass the probe of the G-M survey meter or ion chamber with the beta window closed 6" above the patient. If the reading i

is 5R/ hour, an estimate of attendant exposure would be SR if treatment should take one hour. Experience shows that it is extremely unlikely that a contamination 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 j that anticipated exposures over SR should be on a voluntary basis.

F. INITIAL BI0 ASSAY SAMPLES l Each of the following bioassay samples should be obtained as soon as possible and labeled with name. date, time and type of specimen. Avoid cross-contamination of samples from external sources of contamination or from

i. other samples.

Blood:

7 (1) 10 ce for radiobioassay; (2) 10 cc (steelle heparinized) for chromosomes; keep samples chilled in a glass of ice; l (3) 10 cc oxalated for hemogram and differential

  • l (4) 10 cc for: ,

i =

(a) chemistries;

(b) electrolytes

! - Hair, nails, metals from neutron-exposed patient; i

! - Urine:

! (1) first urines (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 i

f - Feces, total sample for several succeeding days; l - 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.1.d. for 3 days or more frequently if clinical condition warrants.

C-5

i Proceduce No. M1-7 Revision 7 (May, 1985)

ATTACHMENT D ,

PROCEDURE FOR THE USE OF PROTECTIVE CLOTHING AND DOSIMETERS e

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Procedure No. M1-7 Revision 7, (May, 1985)

ATTACHMENT D PROCEDURE FOR THE USE OF PROTECTIVE CLOTHING AND DOSIMETERS All work past the Monitoring (Control) Point requires protective clothing, independent of the degree of contamination present on the patient or his clothing. Each person entering REA should don two surgical gowns, two sets of ,

surgical gloves, and two vinyl aprons, mask, cap and shoe covers, as well as dosimetry. (See Diagram II for donning protective clothing and proper placement of attendant dosimetry). After gross decontamination is completed, the outer surgical gown, gloves and apron are removed. Wound care and decontamination will then be attended to.

Removal of Contaminated Protective Clothing Upon completion of their activities in the Radiation Emergency Treatment Room personnel will proceed to the Monitoring (Control) Point between the Treatment Room and the Buffer Zone (Diagram I). They will remove their protective clothing and personnel dosimeter in the following order:

(1) self-reading dosimeters (read and recorded by Control Point Attendant);

O (2)

(3)

(4) headwear and mask; apron and gown (turning them inside-out);

footwear and gloves (remove at Step-Off Pad).

Clearance Procedures After having removed protective apparel, each person who occupied the Treatment Area will be monitored prior to leaving the Buffer Zone. If no con-tamination is found, personnel may proceed to the change area and put on their normal clothing.*

  • If contamination is found, personnel will remain in the Buffer Zone, away from the normal exit. Salem Nuclear Generating Station / Hope Creek Generating Station personnel will direct them through a decontamination process utilizing the water supply, soap and water collection system available in the treatment room. A final survey will be performed at the control point prior to entering the clean part of the hospital.

D-1

t Procedure No. M1-7

\~y/ Revision 7 (May, 1985)

ATTACHMENT D (Continued) 9 Use of Dosimeters Dosimeters will be supplied by the Monitoring (Control) Point Attendant to all personnel entering the Radiation Emergency Area. l

\

Dosimeters are of three types: .

l

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1. Direct coading dosimeters (" pencil dosimeters") to monitor ex-

' posed dose on a continuing basis. These must be recharged to read "zero" before they are distri,buted to each attendant.

2. Badge (TLD) dosimeters - to form a permanent record of exposure.
3. Ring (TLD) dosimeters - to form a permanent record of finger en-posure.

Dosimeters are to be worn in the following manner:

(1) It the neck line, clipped under the protective clothing:

O (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 processing. 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 Radiation Emergency Area.

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I Procedure No. M1-7 Revision 7. (May, 1985)

ATTACNMENT E PROCEDURE FOR PATIENT DECONTAMINATION AND SANFLE TAEING f

m Procedure No. M1-7 Revision 7 (May, 1985) l ATTACHMENT E '

PROCEDURE FOR PATIENT DECONTAMINATION AND SAMPLE TAKING General These procedures cover the use of the Decontamination and Sample Taking ,

Elts. The kits provide all the necessary items for the decontamination of a radioactively contaminated patient and the collection of specimens of this contamination.

The collection of specimens is a prerequisite for a thorough evaluation of the medical and radiation status of the patient. It should be performed in conjunction 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 replenishment. The intended use of several of the items is indicated on the parts list.

Patient Decontamination Procedures Princloles The objectives of decontamination are:

1. To prevent injury caused by the presence of radioactive substances on the body;
2. To prevent the spread of contamination over and into the patient; and
3. To prevent attending personnel from becoming contaminated themselves or (in extreme cases) from being exposed to a source of radiation.

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

Decontamination is essentially the physical removal of radioactive material from the skin, wounds, or body orifices. Most decontaminants cont'ain detergents or other chemical agents to facilitate this removal. Therefore, most decontaminants are suitable for decontamination of the intact skin only, and are not appropriate for wound cleansing or 1rrigation of body orifices.

E-1 O .

()

s-s' Procedure No. ML-7 Revision 7, (May, 1985)

ATTACHMENT E (Continued)

Patient Decontamination Procedures (Continued)

Decontamination is performed in the following manner:

1. From the highest level of contamination to the lowest; ,
2. Starting with the simplest procedure (e.g., soap and water) to more compilcated 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 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 seen below).

Decontamination Procedures s

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.

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

1. Check the effectiveness of the technique applied by monitoring periodically; and
2. Avold the spread of radloactive materials from the area being decontamlnated to areas of lesser contamination by covering the adjacent area.

E-2 a .

I T Procedure No. M1-7

\m / Revision 7, (May, 1985)

ATTACHMENT E (Continued)

Decontaminati'on Procedures (Continued)

Decontamination sequence should proceed as follows:

1. Wounds and adjacent skin; ,
2. Body orifices and adjacent skin;
3. High level intact skin;
4. Low-level skin areas.

B. Steps To Be Taken For Decontamination and Sample Takinz

1. Judge whether the patient's medical condition requires immediate intervention; stabilize wound, if necessary, and redress for later decontamination;
2. Obtain a briefing from Salem Nuclear Generating Station / Hope Creek Generating Station personnel as to the contamination 4

0 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;

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 SHOULD 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; E-3 O

Procedure No. M1-7

( Revision 7 (May, 1985)

ATTACHMENT E (Continued)

Decontamination Procedures (Continued)

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

7. Proceed with wound survey and decontamination (see Procedures ,

for Decontamination of Wounds);

8. Complete detailed decontamination of patient;
9. Transfee patient to " clean" area of hospital (see Diagram III).

Waste material will be appropelately collected and returned to Salem Nuclear Generating Station / Hope Ceeek Generating Station for disposal.

C. Decontamination of Skin

1. Take smear sample of area (See " Sample Taking Techniques and Indications");
2. Protect adjacent area if indicated by covering with towels;

('

3. Cleanse skin area; wash thoroughly with Turco soap and tepid water, using either cotton balls, preop sponges or surgical brushes, cover area with a good lather; cinse 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. If contamination persists, repeat step (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 decontaminants with water; monitor; record results;
6. After complete decontamination, dry skin and apply Nivoa cream to abraded or injured areas; E-4

l O

Procedure No. M1-7 Revision 7 (May, 1985)

ATTACHMENT E (Continued)

C. Decontamination of Skin (Continued)

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;

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

NOTE: In case of serious contamination around a wound, rapid re- l moval of the bulk of radioactivity can be obtained by '

shaving. In case of serious contamination of hair or l

, under nails, clip nails, remove hair and scrub thoroughly '

and repeatedly with intermittent surveying, j D. Decontamination of Body Orifices 5

1. Take samples of activity in nostrils, ear canals, and other 1

orifices as indicated (see " Sample Taking Techniques and Indications");

1

2. Decontaminate area surrounding orifices;
3. Gently clean orifices using wetted swabs; 4 If nose swab indicates 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 adjacent to wound; E-5 e

i Procedure No, M1-7

= l'~' Revision 7, (May, 1985)

ATTACHMENT E (Continued)

E. Decontamination of Wounds (Continued)

4. Depending on surface and depth of wound, irrigate wound with steelle saline, dab with gauze pads soaked in sterile saline to cleanse wound; collect all materials used and place in separate ,

labeled containees;

5. Remove obviously necrotic and devitalized tissue surgically; keep all tissue specimens removed:
6. Repeatedly monitor wound; record results on patient record sheet;
7. If contamination persists, consult with RMC to determine further course of action:
8. If wound is clean, treat wound as necessary.

Procedures for Sample Taking

  • Principles The objectives of collecting specimens from a radioactively contaminated patient are as follows: ,

b

1. 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
3. To supply information on the biological injury inflicted by the radiation.

To meet these objectives, 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.); .

E-6

g Procedure No M1-7 i Revision 7, (May, 1985)

ATTACHMENT E (Continued)

Procedures for Sample Takinz (Continued)

3. In case of neutron irradiation ... materials in which neutron induced radioactivity may be present (gold rings, buttons, hair, nati clippings); ,
4. Hemat 31ogical specimens (whole blood in heparinized, oxalated and uncoated 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 separately from the usually bulky samples with rather low radioactivity (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, take care to properly collect, store and mark all samples.

Sample Takinz Techniques and Indications External contamination:

. Before decontamination, the following samoles shall be obtained: ,

1. Skin Smears: use Nucon smear pads, moisten with a few drops of water, and smear a skin area of about 100 cm2 (4a x 4*), gg 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 recced paper, record location and time and area smeared, if other than 100 cm2 and place in envelope. Alternatively, tape may be used to remove l contaminants for later examination.
2. Take samples of nails, hair and collect metallic objects (rings, watches, glasses, belt buckles, etc.).

1 E-7

I Procedure No. M1-7 N Revision 7, (May, 1985) l

)

ATTACHMENT E (Continued) 1

- Sample Takinz Techniques and Indications (Continued)

External Contamination (Continued)

3. Wound Samples: use either one of the following methods: ,

- for large wounds with vlsible blood or wound fluid --

obtain a few cc using an eye dropper or syringe; transfer to bottle and label;

- for superficial wounds -- c'ub gently with cotton swabs; 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

1. Body Orlfices: 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  ;

volding.

External Exposure:

In all cases where a total body exposure is suspected:

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 bloassay samples to kit. With any specimens necessary to the emergency medical 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.

E-8

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ATTACHNENT F l

PARTS LIST FOR DECONTANINATION AND SANFL5 TAKINC KITS l r

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h.O Procedure No. M1-7 l Revision 7, (May, 1985) ]

ATTACHMENT F DECONTAMINATION KIT  !

Skin Decontaminants Quantity Betadine

,, 1 ,

Turco 1 Phlsohen 1 Cloros 1 Corn Heal 1 Tide 1 Shampoo 1 -

Wound (Or Skin) Decontaminants' saline 2 4

E-Z Props 10 ,-

Hydrogen Peroxide 1 Materials for Decontamination E-Z Scrubs 10 Towels 10 Gauze Pads 15 Q-Tips 15 Surgical Cloves 10 Solution Bowls 2 F-1

a Procedure No, M1-7 Revision 7. (May 1985)

ATTACNMgNT F (Continued)

DECONTAMINATION KIT (Continued)

Quantity Hatorials for Decontamination (Continued) ,

Irrigation Syringe 1 Shave Prep Kit 1 Miscellaneous Items Procedure for Decontamination 1 Skin Cream 1 Colloidin 1 Ster! Drape 1 Marker 1 Pen 1 Clipper 1 Surgical Tape 1 Plastic Bass 10 F-2

O v

Procedure No. M1-7 Revision 7 (May, 1985)

ATTACHMENT F (Continued)

SAMPt.E TAKING KIT sample Twee Samolina Instrument Ouantity Nasal swabs 4 Aural swabs 4 Oral swabs 4 Skin Folds swabs 4 Swipes swabs 4 Swipes Nucon smear 25 slots Male small container 4 Nalls small container 4 Metallic Objects medium container / 2 small plastic bass 2 large Blood 10 cc vacutainers 2 heparinized -

(green) '

1 oxalated (gray) 1 sterlie (red)

Urine (24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br />) 2000 ce plastic container 1 Feces focal container 2 Wound Exudate swabs 4 eyedropper & bottle 2 Tissue containers 2 small 2 medium Vomitus fecal container 2 Irrigation flulds 100 cc plastic bottle 2 F-3

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. l l

Procedure No, M1-7 Revision 7. (May, 1985)

ATTACHMENT F (Continued)

SAMPLE TAKINC KIT CONTENTS Miscellaneous Items Quantity Envelopes 10 Labels 50 Pens 1 grease I wetting Scissors 1 Tweezers 1 C11ppers 1 e

F-4 e

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\ Procedure !!o. M1-7 Revision 7, (May, 1985) e n 'O ATTACHMENT C REA STORED SUPPLIES & EQUIPMENT 1

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P. M ure No. Ml-7

ATTACHMENT G Revision 7, (May, 1985) 1 -

REA STORED SUPPLIES & EQUIPMENT r

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INVENTORY OF THE RADIATION EMERGENCY MEDICAL SUPPLIES & EQUIPMENT Salem County Memorial Hospital ITEM QUANTITY Decontamination kit, new style 1 ,

Sample Taking Kit 1 Decontamination Table Top complete 1 w/ splash guards and stretcher insect Barrel, 15 gal 2 Barcel, 20 gal., mobile, white plastic 1 Barrel, 32 gal., w/ mobile base 3 Herculite, white, green, yellow sufficient g Bags, plastic, 32 gal. 10 Lead pig 1 Poster, CPR, wall-mounted 1 Poster, Radiation Accident, wall- 1 mounted Rope, yellow / magenta sufficient Shield, mobile, lead glass 1 Showeehead w/ hose 1 Sign, radiation warning w/ insects 10 Sis;n, " Caution Radiation Area", metal 1 Step-off pad 2 Tape, masking, 2" .s 10 i

G-1 L- -

Procedure Ab. M1-7 1

' l ' Revision 7, (May, 1985)

.ATTt N E G (Continued)

L[mj)

  • . REA S'IORED SUPPLIES & EQUIPMEBE ITEM QUANTITY INSTRUMENTS: ,

Charger, dosimeter - Johnson 1 Model CAT 6 Dosimeter, SRD, 0-1 R 9 '

Ceiger Counter 1 Eberline Model E-520 Count Rate Meter 2 each l Eberline Model E-140N Constant Flow Air Sampler 1 RADECO Model HD 29A I

f% Glass Filter 47 mm sufficient Filters CESCO. sufficient TLD, control 1

NOTE: Instruments. maintained and calibrated by plant EQUIPMENT:

Air vent plugs 5 Ambu resuscitator 1 Bucket, mobile, stainlesa steel 1 IV Stand 1 Mayo Stand 1 0xygen resuscitator, wall-mounted 2 Resuscitator, manual .

1 l G-2 l

L- -

Procedure No. M1-7 g Revision 7, (May',1985) i '

ATTACHMENT G (Continued)

REA S'IORED SUPPLIES & EQUIPMENT ITEM QUANTITY Sphygmomanometer, wall-mounted 2 Surgical lamp, ceiling-mounted 1 Waste receptacle, metal 1 cueney 1 Clock, wall-mounted 1 CLOTHING / LINEN SUPPLIES Apron, plastic, box 1 Cloves, surgeon's sufficient Protective Clothing Packs: (RMC type) 20 Aprons (2)

Cap (1)

Cloves, surgeon's (2) pr Cowns (2) l O. Mask Shoe Covers, yellow (1)

(1) pe plastic l -

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Procedure No. M1-7 Revision 7 (May, 1985) e

  • ATTACHMENT H RADIATION EMERGENCY TELEPHONE DIRECTORY O -

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1 Os Procedure No. M1-7 Revision 8 (June, 1985)

ATTACHMENT H RADIATION EMERGENCY TELEPHONE DIRECTORY Nizht Salem County Memorial Hospital Day '

Emergency Room 609-935-1000 Ext. 3231 J. Michael Calvin 609-935-1000 Ext. 3201 609-299-0079 president Alberta Clour, R.N. 609-935-1000 Ext. 3379 609-935-6515 Vice President / Nursing Joanne Brodrick, R.N. 609-935-1000 Ext. 3246

~ ~

609-468-5496 In service Education Coordinator William L. Wilson 609-935-1000 Ext. 3324 609-935-2047 Director, Plant Operations Paul Fredericks 609-935-1000 Ext. 3207 609-678-3654 Sr. Vice President Wilbert Staub, M.D. 609-935-1000 Ext. 3326

. Chief of Staff Public Service Electric & Gas Company, 80 Park Place, Newark, NJ 07101 Bernard Reilly, M.D. 201-430-5930 201-773-2476 Medical Director Ronald J. Mack, M.D. 609-339-4100 609-573-4588 Assistant Medical Director (Page Number)

Coordinatina Physicians  !

John R. Castiglioni, D.O. 609-935-1000 Ext. 3231 609-769-3152 John Madara, M.D. 609-935-1477 609-935-2220 j 31 Market Street Salem, NJ 08079 ,

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- Procedure No. M1-7 Revision 8 (June, 1985)

ATTACHMENT H (Continued)

RADIATION EMERGENCY TELEPHONE DIRECTORY Day Night Ambulance Service Lower Alloways Creek Ambulance 609-935-4222 609-935-4505

. . (General Business) (Emergency #)

Sales Nuclear Generating Station John Zupko 609-339-4500 General Manager John Treio 609-339-4399 Radiation Protection Manager Salem Operations J. Russell Lovell 609-339-3736 e Radiation Protection Manager

'(

t Hope Creek Operations Paul Eldreth 609-339-4572 Noclear Fire & Safety Manager Dennis McCloskey 609-339-4274 Nuclear Emergency Preparedness Manager Wayne L. Britz 609-339-4546 Manager, Radiation Protection Services Senior Shift Supervisor - Salem 609-339-4027 Senior Shift Supervisor - Hope Creek 609-339-3669 Radiation Manaaement Corporation Emergency: PRIMARY 215-243-2990 SECONDARY 215-841-5141 GENERAL BUSINESS 215-243-2950 (Philadelphia) 312-310-8650 (Chicago)

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s Procedure No. M1-7 Revision 7, (May, 1985) 6 ATTACHMENT I LOCATION OF MANUALS 9

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ATTACHMENT I LOCATION OF MANUALS Copy Number Location Radiation Management Corporation 1 Philadelphia Office Salem Nuclear Generatinz Station 2 Manager, Radiation Protection Services 3 EOF Locker 4 Radiation Protection Madag~er - Sales Ops 5 Radiation Protection Manager - Hope Creek 6 Nuclear Department, Safety Supervisor 7 First Aid Room Salem County Memorial Hospital f-'s 8 President 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 Coordinatinz Physicians 15 John R. Castiglioni D.O.

19 John Madara, M.D.

Public Service Electric & Gas Company 16 Medical Director 20 Assistant Medical Director l

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Procedure No. M1-7 Revision 7, (May, 1985) l l

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