ML20138R470
| ML20138R470 | |
| Person / Time | |
|---|---|
| Site: | Limerick  |
| Issue date: | 12/24/1985 |
| From: | Conner T CONNER & WETTERHAHN, PECO ENERGY CO., (FORMERLY PHILADELPHIA ELECTRIC |
| To: | Edles G, Gotchy R, Kohl C NRC ATOMIC SAFETY & LICENSING APPEAL PANEL (ASLAP) |
| Shared Package | |
| ML20138R459 | List: |
| References | |
| NUDOCS 8512310301 | |
| Download: ML20138R470 (68) | |
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' ML*: Ky L AW OFFICES Coxs en & Warrenf r Airs, e.c.
17 4 7 P?.N N NY LVA NI A AV E N U E. N W.
T Roy B. conn E R. J R.
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M A R E J. W ETT E N H A N N ROBERT M. MADER DOL'O LAs E. OLSON J2BSICA H.1hv5HTY December 24,.g8gc0 30 NO 56
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ROB E NT H. Pt* RL L.
IJOJ' M l B 5 %O0 liiCHNHARD D. BEC H MOEFER C A tu. E A DD N F.4 9 AIOnet.Aw LFF!,: -
v' 00CnLI C a M"'
BRANCH Christine N. Kohl, Chairman Dr. Reginald L. Gotchy Atomic Safety and Licensing Atomic Safety and Appeal Board Licensing Appeal Board U.S. Nuclear Regulatory U.S. Nuclear Regulatory Commission Commission Washington, D.C.
20555 Washington, D.C.
20555 Gary J.
Edles Atomic Safety and Licensing l
Appeal Board l
U.S. Nuclear Regulatory Commission Washington, D.C.
20555 In the Matter of l
Philadelphia Electric Compani (Limerick Generating Station, Units 1 and 2)
Docket Nos. 50-352 and 50-353
Dear Board Members:
i In accordance with our professional obligations as l
counsel to keep the Board and parties informed of recent developments, we are enclosing a recently generated draft of the basic procedures, a
list of medical supplies and equipment, and a training outline for the handling and treatment of radioactively contaminated and injured patients who would be admitted by Montgomery Hospital.
This potentially relates to the denied contention appealed by the Graterford inmates as to utilization of Montgomery Hospital for the treatment of any contaminated and injured inmates.
Sincerely, p.
oy onner, Jr.
Counsel for Philadelphia Electric Company cc:
Service List w/o enclosures Angus Love, Esq. w/ enclosures
&2310302 B52224 O
ADOCK 05000352 PDS
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Procedure No. M1-18 Revision 0, (December, 1985)
DECONTAMINATION AND TREATMENT OF THE RADI0 ACTIVELY CONTAMINATED PATIENT AT MONTCOMERY HOSPITAL Approved by Roger E. Linnemann, M.D.
President, RNC Medical Services Division Uncontrolled Controlled
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Procedure No, M1-18 Revision O.
(December, 1985)
DECONTAMINATION AhD TFEATMENT OF THE RADI0 ACTIVELY CONTAMINATED PATIENT AT MONTGOMFAY HOSPITAL TABLE OF CONTENTS TITLE PACE NO.
REV/DATE A.
PURPOSE AND
SUMMARY
1 0 12/85 B.
CENERAL INFORMATION 2
0 12/85 C.
PREREQUISITES 1.
Alert / Notification 2
0 12/85 2.
Pelor Action at Limerick Cenerating Station 3
0 12/85 D.
LIMITATIONS AND ACTIONS 3
0 12/85 E.
PROCEDURE 1.
Notification / Emergency Department Charge Nurse 3
0 12/85 2.
Nursing Supervisor's Dulles 4
0 12/85 3.
Maintenance 5
0 12/85 4.
^ Nursing Personnel Duties 7
0 12/85 5.
Attending Physician's Dulles 8
0 12/85 6.
Control Points Attendant's Duties 9
0 12/85 7.
Buffer Zone Nurse's Duties 10 0 12/85 8.
Security's Duties 11 0 12/85 9.
Administration Duties 12 0 12/85 10.
Radiation Safety Officer's Duties 13 0 12/85 11.
Plant Health Physics Technician's (HPT) Dutles 14 0 12/85 F.
RETURN OF REA TO NORMAL USE 16 0 12/85 C.
PATIENT TRANSFER TO DEFINITIVE CARE CENTER 16 0 12/85 H.
PROCEDURE FOR HANDLING MULTIPLE VICTIMS 16 0 12/85
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Procedure No. M1-18 Revision 0, (December, 1985)
TABLE OF CONTENTS (Continued)
REV/DATE DIAGRAM I Radiation Emergency Area - Plan View 0 12/85 DIACRAM II Attendant Garb 0 12/85 DIAGRAM III Clean Floor Covering as Utilized for 0 12/85 Pallent Transfer ATTACHMENT A Quick Sort Procedure for liandling Any 0 12/85 Radiation Accident Victim ATTACHMENT B Telephone Procedure for Radiation Accident 0 12/85 Emergencies: Emergency Department Charge Nurse ATTACHMENT C Emergency Treatment of Radiation Accidents 0 12/85 ATTACHMENT D Procedure for the Use of Protective 0 12/85 Clothing and Dosimeters ATTACHMENT E Procedure for Patient Decontamination and 0 12/85 Sample Taking ATTACHMENT F Parts List for Decontamination and Sample 0 12/85 Taking Kits ATTACHMENT C REA-Stored Supplies and Equipment 0 12/85 ATTACHMENT H Radiation Emergency Telephone Directory 0 12/85 ATTACHMENT I Location of Manuals 0 12/85 ATTACHMENT J Personnel Dosimetry Log & Patient Data 0 12/85 Sheets 4
i
Procedure No. M1-18 Revision 0, (December, 1985)
REVISION.9 PACE MONTCOMERY HOSPITAL Rev, No.
Date 0
12/85
l l
Procedurt No M1-18 Revision 0, (December, 1985)
DECONTAMINATION & TREATMENT OF THE l
RAD 10 ACTIVELY CONTAMINATED PATIENT AT MONTGOMERY HOSPITAL l
l A.
PURPOSE AND
SUMMARY
r 1.
By agreement between Philadelphia Electric Company and Montgomery Hospital, personnel at Limerick Generatine Station sustaining injuries from lonizing radiation or injuries complicated by radiation. exposure or radioactive contamination will be provided care and treatment at Montgomery Hospital. Montgomery Hospital is a secondary support hospital facility for Pottstown Memorial Medical Center.
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 be admitted, decontaminated and treated in accordance with these i
procedures.
I L
3.
The' purpose of these procedures is to assure the protection of the hospital staff, other patients and visitors during admission and treatment of the radioactively contaminated patient. The hospital's protection program starts at Limerick Generating Station with an alert or warning telephone call to the hospital with information that there has 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 (REA) that has been established in Trauma Room 1 of the Emergency Department.
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 D " Procedure for the Use of Protective clothing and l
Dosimeters". Decontamination of the patient (s) as may be required, and the collection of contamination samples will follow the j
directions given in Attachment E.
l.
a Procedure No. M1-18 Revision 0, (December, 1985)
D.
GENERAL INFORMATION There are three major types of radiation exposure which may cause injury:
1.
penetrating radiation exposure from a source external to the body (gamma 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 burn
-patient will harm the attendant.
A patient who has received an overdose of radionuclides by ingestion or inhalation is no more of a hazard than the patient who has been given diagnostic radioisotopes in a hospital nuclear medicine department.
Equally without hazard to others is the patient who has received an overdose of radionuclides by ingestion or inhalation. Internal contamination alone is no more hazardous than diagnostic radioisotopes administered to a patient in the hospital clinic. However, if internal contamination is present, external contamination may also be present.
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 procedures to prevent the spread cf 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, aleway obstruction, shock.
Concomitantly, or as soon as possible, the patient should be decontaminated.
C.
PREREQUISITES 1.
Alert / Notification As soon as it has been established by Limerick Generating Station 4
1 personnel that a patient will be transported to the hospital for treatment, an alert call to this effect will be given. The alert and notification calls will be directed to the Emergency Department Charge Nurse (215) 270-2060 (see E.1 below). The Charge Nurse wll1, i
In turn, notify Administration and the Nursing Supervisor.
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i Procedure No. M1-18 Revision O.
(December, 1985) i C.
PREREQUISITES (Continued) 1 2.
Prior Action At Limerick Generating Station Before sending the patient (s) to the hospital, Limerick Generating Station personnel will accomplish the following procedures:
I a.
Administer first aid.
j b.
Notify ambulance.
Call the hospital and inform them of expected arrival timo, c.
description of apparent injuries and number of patients.
d.
Decontaminate the patient (s) to an extent compatible with injuries.
Assign a radiation protection technician quallfled in radiation e.
i protection procedures to accompany the patient (s).
]
D.,
LIMITATIONS AND ACTIONS 1.
l Montgomery Hospital is the secondary support treatment feellity where radioactively contaminated accident casualties from Limerick j
Generating Station may be treated.
j 2.
Should Pottstown Memorial Medical Center have to evacuate, contaminated and injured patients frow Limerick will go to j
Montgomery Hospital.
l 3.
All decontamination of hospital personnel, equipment and facilities i~
shall be the responsibility of Limerick Generating Station personnel.
4 I
E.
PROCEDURE i
1.
Notification / Emergency Department Charge Nurse In accordance with paragraph C.1, Limerick Generating Station j
personnel will alert the hospital.
It will be the responsibility of
]
the Charge Nurse to notify Administration and the Nursing Supervisor
]
and complete the Data Information Sheet seen under Attachment 8 of i
this manual.
Next, the Charge Nurse should place a return call to Limerick i
Cenerating Station (327-1200, Ext. 2125) to verify impending patient arrival. See E.2.8 which follows for additional responsibilities.
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Procedure No, M1-18 Revision 0, (December, 1985)
E.
PROCEDURE (Continued) d 2.
Nureing Supervisor's Duties Prior to Patient Arrival A.
Notify the following personnel:
i 4
3 1.
Emergency Department Physician.
t 2.
Emergency Department Nursing Personnel.
3 3.
Radiation Safety Officer.
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4 Maintenance.
1 f.
Security.
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Laboratory.
B.
With assistance from Charge Nurse, perform the following:
l 1.
Assign nursing personnel to assist attending physician in 3
j treatment room.
I 2.
Assign Control Point Attendant.
t 1
j 3.
Assign Buffer Zone Nurse.
1 4
Assure that the REA is prepared to receive patient (s),
t 5.
Assure that appropriate and sufficient medical supplies
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are brought to the REA.
l Patient Arrival i
Coordinate all activities in treatment room and buffer zone.
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i Procedure No. M1-18 Revision 0, (December, 1985)
E.
PROCEDURE (Continued) 3.
Maintenance A.
Upon notification from the Nursing Supervisor of impending patient (s) arrival, Maintenance personnel will prepare the REA as follows:
Prior to Patient Arrival Step 1 Clear decontamination / treatment room of non-stationary supplies and equipment, i
Step 2
{
Obtain radiation emergency supply cart from storage area, i
Step 3
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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) Treatment Room (2) Ambulance Entrance and hallway to Treatment Room 1
3 b.
Green Herculite -- buffer zone i
c.
White Herculite -- use for patient exit only.
Step 4 i
Lay yellow Herculite on outside ambulance dockint area.
Step 5 i
4 Attach decontamination table top _to gurney and place water receptacle under drain.
Place waste receptacles with platic liners in decontamination / treatment room and buffer zone.,
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Procedure No. M1-18 Revision O.
(December, 1985)
E.
PROCEDURE (Continued) 3.
Maintenance (Continued)
Sten 6 Erect stanchions and attach warning rope and signs across hallway and buffer zone.
Step 7 Attach hose with showerhead to faucet and adjust water temperature (1ike warm).
Step 8 Place Decontamination and Sample-Taking Kits on counter in treatment TOOm..
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1 Procedure No. M1-18 Revision 0, (December, 1985)
E.
PROCEDtfRE (Continued) 4.
Nursing Perso'nnel Duties Prior to Patient Arrival
'A.
. Don protective clothing and dosir.uters in accordance with directionticontained in Attachment D of this manual.
B.
Wait in treatment room for patient arrival.
C.
Request additional Nursing perronnel for Emergency Department as needed.
~ Patient Arrival A.
Assist attending physician in patient stabilization.
B.
Collect bioassay samples in accordanca with directions contained in Attachment E of this manual.
C.
Perform decontaminatiod of the patient in accordance with j
directions-contained.in Attachment E of this manual.
Plant health physics personnel may be called upon for guidance if necessary.
1 D.
Assist in patient transfer and exit procedures.
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E.
Remove protective clothing and dosimeters in accordance with directions contained in Attachment D of this manual.
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Procedure No. M1-18 Revision O. (December, 1985)
E.
PROCEDURE (Continued) 5.
Attending Physicisp's Duties Prior to Patient Arrival A.
Assure that the Radiation Emergency Area is set up for admission of a radioactively contaminated patient.
B.
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 D of this manual.
D.
Request additional physician assistance to cover Emergency Department.
E.
Notify appropriate medical specialist.
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 admitted according to triage method.
i B.
Question the accompanying Limerick Generating Station personnel concerning the patient's contamination status and precautions that should be taken by the hospital staff.
C.
Administer emergency treatment.
D.
Ensure 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 soction 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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N Procedure No. ML-18 Revision O.
(December, 1985)
E.
PROCEDURE (Continued) f 6.
Control Point Attendant's Duties i
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 of this manual.
C.
Restrict access to only those personnel authorized entry by the attending physician or Nursing Supervisor.
D.
Maintain a record showing name and time of each person entering 3
l or exiting REA.
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E.
Record serial numbers of dosineters, film badges and TLDs, as well as person's name (see Attachment J. Personnel Dosimetry Log).
Patient Arrival A.
Assure that yellow Herculite in hallway and outside area is rolled up and clean as soon as patient is brought into treatment room.
B.
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 Limerick Generating Station t
personnel and found to be " clean",
i.e., free of detectable radioactive contamination.
C.
Record results of radiation surveys performed by plant health physics personnel on anatomical diagrams provided in the decontamination kits and Section J of this manual.
D.
Record dosimeter readings and collect dosimetry from all individuals exiting the REA.
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Procedure No. M1-18 Revision O.
(December, 1985)
E.
PROCEDURE (Continued) 7.
Buffer Zone Nurse'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 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.
(1) Roll white Herculite from Buffer Zone 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 decontamination table top to the clean stretcher.
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Procedure No. M1-18 Revision 0, (December, 1985)
E.
PROCEDURE (Continued) 8.
Security's Duties Prior to Patient Arrival 1
-Remain outside of ambulance entrance to REA to direct ambulance to 4
pecper entrance.
Patient Arrival J
)
A.
Following ambulance arrival, erect radiation warning rope l
around ambulance.
j.
B.-
Restrict unauthorized personnel from access to (enclosed)
]
ambulance area.
j C.
Assure that ambulance remains at hospital until it has been monitored by Limerick Generating Station personnel.
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Procedure No, M1-18 Revision 0, (December, 1985) 1 E.
PROCEDURE (Continued) 9.
Administration Duties A.
Assure that a responsibic hospital representative is available to address any media concerns.
B.
Assure that a representative from Philadelphia Electric Company is available to address any media concerns.
C.
Provide support for additional personnel if required. -
Procedure No. M 1-18 Revision O.
(December, 1985)
E.
PROCEDURE (Continued) 10.
Radiation Safety Officer (Or Designee) Duties Perform duties outlined in E.11 (which follow) in absence of plant health physics technician #2..
I Procedure No. M1-18 Revision O.
(December, 1985)
E.
PROCEDURE (Continued) 11.
Plant Health Physics Technician's (HPT) Duties Prior to Patient Arrival A health physics technician (HPT #1) from Limerick Generating Station will accompany the patient (s) in the ambulance and bring appropriate instrumentation.
A second health physics technician (HPT #2) will arrive at the hospital in a separate vehicle and assist in the duties outlined below.
Patient Arrival HPT #1 A.
Provide advice and guidance to attending staff regarding radition 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 equipm?nt following pallent and attendant exit.
HPT #2 4
A.
Survey ambulance and attendants prior to departure.
If contamination is found, ambulance shoula be returned to Limerick Generating Station for decontamination.
B.
Control patient and attendant exit procedures.
C.
Perform radiation surveys of patients and attendants upon exit from the REA. !
Procedure No. M1-18 Revision 0, (December, 1985)
E.
PROCEDURE (Continued) 11.
Plant Health Physics Technician's (HPT) Duties (Continued)
RPT #2 (Continued)
D.
Collect dosimetry from personnel exiting the REA at termination of emergency and return to Limerick Cenerating Station for processing.
E.
Decontaminate REA and equipment following patient and attendant exit..
Procedure No. M1-18 Revision 0, (December, 1985)
F.
. RETURN OF REA TO NORMAL USE 4
Once the patient has been decontaminated, the REA and all equipment will be surveyed, decontaminated as required and released as soon as possible
- by Limerick Generating Station health physics personnel.
G.
-PATIENT TRANSFER TO DEFINITIVE CARE CENTER 1.
If it is determined by the attending physician, Medical Director, Philadelphia Electric Company and Radiation Management Corporation that the patient-should be transferred to a definitive care center for the evaluation, diagnosis and long-term care of the radiation injury, this pallent_can be transferred to RMC's definitive care center located at the Hospital of the University of Pennsylvania in Philadelphia.
2.
Arrangements fce 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 J
1.
Multiple injuries occurring at Limerick Cenerating 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 secondary consideration. Upon notification from Limerick Generating Station that there has been an accident involving more than one patient, complete the form seen under Attachment B, 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 Department physician.
2.
On-site medical personnel with the assistance of ambulance i
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 transportation and patients' medical condition warrant, further decontamination (e.g., bathing with soap and water) can be accomplished.
Each contaminated patient sont to the hospital should be accompanied by a trained health physics technician.
Less seriously injured victims should be completely decontaminated i' 1
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Procedure No. M1-18 Revision 0, (December, 1985)
H.
PROCEDURE FOR HANDLING MULTIPLE VICTIMS (Continued) at the plant and be transported to the hospital in a " clean" ambulance to the normal Emergency Department entrance.
i 3.
The medical triage team should dress in protective clothing (see Attachment D).
The present REA 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 decontamina-tion / 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 contaminated 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 hr.ve been treated and decontaminated, the REA i
should be closed off; Limerick Generating Station personnel should survey and decontaminate hospital supplies, equipment, ambulances j
and the area prior to releasing it for routine usage.
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Procedure tio. fil-18 Revision 0, (December,1985) f10tiTG0MERY HOSPITAL PLAtt VIEW OF REA TRAUMA ROOM I I
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Procadure No. M1-18 Nevision O. (December, 1985)
ATTACHMENT A j
QUICK SORT PROCEDURE FOR }{ANDLING AE RADIATION ACCIDENT VICTIM e
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a Procedure No, M1-18 Revision O. (December, 1985)
ATTACHMENT A Quick SORT Procedure for Handling Ang Radiation Accident Victim at the Emergency Room Unloading Dock 1.
Ascertain whether the patient is CONTAMINATED (Use GM Tube)
If so... Admit the patient to REA Ambulance Entrance when set up A.
as Radiation Emergency Area (REA).
B.-
If not... Admit to normal Emergency Room.
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C.
If in doubt... Admit patient to REA.
2.
Treat traumatic 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) 310-8650 PROCEDURE FOR ADMISSION OF UNANNOUNCED ACCIDENT VICTIM (S)
BY EMERGENCY ROOM PERSONNEL l
l Admission l
Culdance is provided for the unannounced arrival of accident patients
>under two circumstances:
(1) Emergency Room personnel become aware of the patient's statuJ as a " radiation accident patient" before the patient has been t
removed from the ambulance; and'(2) the patient has been brought into tho l
Emergency Room before his status as a " radiation accident patient" has been determined.
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s procedure No. M1 1H Revision O.
(December. 1985)
ATTACHMENT A (Continued)
Patient Stllt in Ambulanco-If general medical condition warrants, sustain patient in ambulance, instruct delver, attendants, and Emergency Room personnel who have been in contact with the patient to stay in the vicinity of the ambulance (but not inside the ambulance).
l l
Clear an area of about 8 feet around ambulance and keep unnecessary l
personnel and vehicles away.
Attend to pallent's medical condition as required. Use surgical gloves and mask.
If inmediate life-saving measures are not necessary, observe patient from a distance. All equipment and l
supplies used to attend to patient MUST stay in vicinity of the ambulance.
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NOT carry anything back to the Emergency Room.
Then:
i
- 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 bringing patient In;
- Instruct delver 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 HEA MJt11 l -
stay there until arrival of radiation monitoring personnel.
Establish a guard at the door, pass Emergency Room supplies ind equipment into REA; but DO NOT allow personnel and equipment to come out;
- Personnel attending patient in REA should stand nest to patient only as long as necessary to perform life-saving measures.
At all other times, stand about five to eight feet back and observe patient; and
- Only persons attending the patient should be in the room.
Radiation Status Discovered Afte_r J missi_on to Ema,pency Room
- Immediately secure the entire 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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procedure No. M1-18 Revision 0, (December, 1985)
ATTACHMENT A (Continued)
Radiation Status Discovered After Admission to Emorr.ency Rnom (Continued)
- Establish a control point through which necessary personnel and equipment pass into restricted 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 Limerick Cenerating Station (see Telephone Dicoctory, Attachment I).
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I Procedure No, M1-18
)
Revision O.
(December, 1985)
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ATTACHMENT Q TELEPHONE PROCEDURE FOR RADIATION ACCIDENT EMERCENCIE0 EMERCENCY DEPARTMENT ClfARCE NURSE 1
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l Procedure No, M1-18 Revision O.
(December, 1985)
ATTACitM ENT,g DATA INFORMATION SHRET The Charge Nurse should obtain the followint. Information from the caller:
Date and Time of Call:
l Person Calling:
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Name of Caller:
Telephone Number:
Accident:
Number of Patients:
Extent of Injuries:
Contamination Status & Location of Contamination (if known):
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Expected Time of Arrival:
H-1 t -.
Procedure No M1-18 Revision 0, (December, 1985)
A_TTAClfMENT C EMERGENCY TREATMENT OF NADIATION ACCIDENTC l
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Procedure No. M1-18 Revision 0, (December, 1985)
ATTACHMENT C EMERGENCY TREATMENT OF RADTATION ACCIDENTS CENERAL 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 tske place in the following order:
- Resuscitation and Stabilization
- Initial Decontamination
- Evaluation of Radiation Status
- Initial Treatment of Radiation Injury RESUSCITATION AND STARILIZATION Since radiation injury is not immediately life-threatening, primary attention should always be directed to traumatic life-threatening injuries --
maintenance of aleway, arrest of bleeding, treatment of shock and control of pain.
DECONTAMINA_ TION Concomitantly with the procedure above, or as soon as possible, the patient should te decontaminated.
In the initial decontamination......
- Remove all clothing;
- Obtain samples of contamination (skin smears, tissue, fluids, etc.);
- Survey with a G-M counter and note 1cvels of contamination on Patient Data Sheets (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 sterlie water and/or saline; C-1
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Procedure No. M1-18 L
Revision 0, (December, 1985)
ATTAC!fMENT C (Continued)
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DECONTAMINATION (Continued) i 1
- Flush orificos will water or saline. Do not allow patient to swallow; I
- Stop with initial decontamination when activity levels are measured in the few thousand counts /minutet 3
See Attachment E for details on decontaminallon and sample
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taking.
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EVAIUATION OF RADIATION EXPOSURE STATUS I'
Dosa Evaluation: This will require the assistance of persons knowledgeable in i
radiation. This assistance can be by someone on location or by telephone.
In any case, gather as much of the following information as possible:
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- Dose rate (gamma, x-ray, neutrons, etc.) as measured by
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instruments in accident environment;
- Radiation exposure reading on patient's and others' dost-meters (TLD, film badge, direct reading dosimeter);
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- Level of residual contaminant (beta, gamma) on patient using i
survey meter (mark area on Patient Data Sheets -- see Attach-l ment J);
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- Neutron exposure? Collect metal objects, hair or nalis t and
- Calculation of dose to the pallent and to attendants.
l Cilnical Picture: A good estimation of the severity of the pallent's external total body exposure can be obtained by observing the following clinical symp-i toms and signs (R = Rems, air esposure) 4
- Nausea and vomiting...
100R l
Beginning within 2 hours2.314815e-5 days <br />5.555556e-4 hours <br />3.306878e-6 weeks <br />7.61e-7 months <br /> 400R l
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 /> 15R l
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s Procedure No. M1-18 Revision O. (December, 1985)
ATTACHMENT,C (Continued)
Clinical Pleture (Continued)
- Erythema...
300R (total body);
600R (surface contact)
- Diarrhea...
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 /> 1200/mm3 good prognosis 300-1200/mm3 guarded prognosis 300/mm3 poor prognosis INITIAL TREATMENT OF RADIATION INJIIRY Detailed Decontamination:
It is particularly important at this stage to remove high level contamination caused by penetrating missiles or splinters in wounds.
Overeuposura:
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.
require antlemetics, fluids, sedatives and analgesics.
He may 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 cc 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, speelfic treatment to eliminate any absorbed radioactivity requires rather detailed and compter 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.
patient's condition warrants.
Arcange for whole body count as soon as Aerange for thyroid uptake study for I-131.
If it has been determined that the patient absorbed considerable amounts of...
Trillum (3 )..... force fluids.
H kadiolodine
..... 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 />).
C-3
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i Procedure No. M1-18 Revision 0, (December, 1985)
ATTACHMENT C (Continued)
PRINCIPf.ES OF RADIATION PROTECTION 1
l 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 belas 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 permissible levels of attendant exposure in the course of treating a patient are:
to SR routine treatment and decontamination
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to 25R emergency treatment and decontamination to 75R lifesaving treatment and decontamination To estimate attendant exposure, pass the probe of the G-M survey meter or lon chamber with the beta window closed 6" above the patient.
If the reading is SR/ 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 that anticipated exposures over SR should be on a voluntary basis, INITIAL BI0 ASSAY S AMPLES Each of the following bloessay 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 other samples.
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s Procedure No. M1-18 Revision O. (December, 1985)
ATTACHMENT C (Continued)
INITIAL BIOASSAY SAMPLES (Continued)
Blood:
(1) 10 cc for radiobioassay; (2) 10 cc (steelle heparinized) for chromosomes; keep samples chilled in a glass of ice; (3) 10 cc oxalated for hemogram and differential *
(4) 10 cc for:
(a) chemistries; (b) electrolytes differential - repeat t.l.d. for 3 days or more frequently if clinical con-dition warrants.
- Hair, nails, metals from neutron-oxposed patient;
- t!.r i n e :
(1) first urine; (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; f
- Vomitus;
- Tissue and tissue exudates (note location);
- Irrigation fluids (note location); and
- Filter paper or cotton smears of orifices, wounds, skin areas (note locations).
C-5
Procedure No. M1-18 Revision O.
(December, 1985)
$TTACHMFNT D PROCEDURE FOR Tite USE OF PROTECTIVE CLOTHING AND DOSIMETERS t-e
Procedure No, M1-18 Revision O. (December, 1985)
ATTACHMENT D PROCEDURE Fr USE OF PROTECTIVE CLOTHING AND DOSIMETERS All work past the
'. Point requires protective clothing, independent of the degree of cont i present on the patient or his clothing.
He t
sure all female atter.1--
Igned to the REA are wearing scrub pants in addition to protectic.
- 1 personnel should remove everything from the pockets of thole uni!.n
,b clothing, in case this clothing must be discarded.
Each perso, e1tur i,
A should don two surgical gowns, two sets of surgical gloves acJ t:
v: 1j. aprons, mask, cap and shoe covers, as well as dosimetry (ser DI.igr.o donning protective clothing and proper placement inc of attendant dos t:tutt y).
After gross decontamination is completed, the outer surgical gow.*, glcees and apron are removed. Wound care and decontamination will then te attended to.
Removal of Contaminated Protectiva Clothl_ng upon completion of their activilles in the Radiation Emergency Treatment Room personnel will proceed to the Control Point between the Treatment Room and the Buffer Zone.
They will remove thole protective clothing and personnel dosimeter (s) in the following order:
(1) self-reading dosimeters (read and recorded by control Point Attendant);
(2) headwear and mask; (3) apron and gown (turning them Incide-out);
(4) 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 by Limerick Cenerating Station health physics technician prior to leaving the Buffer Zone.
If contamination is found, personnel will remain in the Buffer Zone, away from the normal exit.*
Limerick Cenerating Station health physics personnel will direct them through a decontamination process uttllting the water supply, soap and water collection system available in the treatment room.
A final survey will be i
performed at the Control Point prior to antering the clean part of the hospital.
- If no c.ontamination is found, personnel may proceed to the change area and put on their normal clothing.
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t Procedure No, M1-18 Novlsion O. (December. 1985)
ATTACHMENT D (Continued)
Me of Dostmeters Dostmeters will be supplied by the Control Point Attendant to all personnel entering the Radiation Emergency Area.
Dosimeters are of three types:
(1) Direct reading dosimeters (" pencil dosimeters") to monitor exposed dose on a continuing basis.
These must be corharged to read "zero" before they are distelbuted to each attendant.
(2)
Badge (TI.D) dosimeters - to form a permanent record of exposure.
(3)
Ring (TLD) dosimeters - to form a permanent record of finger exposure.
Dosimeters are to be worn in the following manner:
(1) 6t the neck line, clipped under the protective clothing; (2)
On the ring fingers of hands, under tho 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 dostmeters 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 Radletion Emergency Area.
These are then given to the health physics technician for reading at the Limerick Generating Station
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(December, 1985)
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ATTACHMENT E PROCEDURE FOR PATIENT DECONTAMINATION AND SAMPLE TAKING
e Procedure No, M1-18 Revision O.
(December, 1985)
ATTACHMENT E PROCEDURE FOR PATIENT DECONTAMINATION AND SAMPLE TAKING General These procedures cover the use of the Decontamination and Sample Taking Kits.
The kits provide all the necessary items for the decontamination of a radioactively contaminated patient and the collection of specimens of this contamination.
1 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 Prinelples The objectives of decontamination cre:
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 dirt from the skin, wounds, or body orifices. Most decontaminants contain detergents or other chemical agents to f acilitate this removal. Therefore, E-1 i
Procedure No. M1-18 Revision 0, (December, 1985)
ATTAC!! MENT E (Continued)
, Patient Decontamination Procedures (Continued) most decontaminants are suitable for_ decontamination of the intact skin only, and are not appropriate for wound cleansing or irrigation of body orifices.
Decontamination is performed in the following manner:
1.
From'the highest level of contamination to the lowest; 2.
Starti.'s with the simplest procedure (e.g.,
soap and wat er) to more complicated procedures; 3.
With due regard to contomination of wounds, body orifices, etc.
(see below for specific guidelines).
Usually, the effect of deem.tamination is greatest in the earliert
- 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 1
In some cases, decontamination may have be9n started before the patient arrives at Montgomery Hospital.
It con be expected that the residual contamination is minor and/or that serious contamination is localized, e.g.,
around and in a wound.
j A.
General i
Two general rules apply to the performance of decontamination:
1.
Check the effectiveness of the technique applied by monitoring periodically; and 2.
Avoid the spread of radioactive materials from the area being decontaminated to areas of lesser contamination by covering the adjacent area.
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9 Procedure No. M1-18 Revision 0, (December, 1985)
ATTACHMENT E (Continued)
Decontamination Procedures (Continued)
Except when prohibitive degrees of contamination are present on/in any of the locations listed below, decontaminatiora is performed in the following order:
1.
High level intact skin; 2.
Body orifices and adjacent skin; z
3.
Wounds and adjacept skin; 4
Low-level skin areas.
B.
Steps To Be Taken For Decontamination and Sample Taking 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 the attending health physics 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; 3.
Remove all clothing and monitor the patient with the radiaticn survey instrument by scanning the entire body (holding the probe about two inches 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 m
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Procedure No. M1-18 i
Revision 0, (December, 1985)
ATTACHMENT E (Continued)
Decontamination Procedures (Continu.d)
B.
Steps To Be Taken For Decontamination and Sample Takink (Continued) 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 Limerick 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.
Cleanso 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; 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 completa decontamination, dry skin and apply Nivea craam to abraded or injured areas; i
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Procedure No, M1-18 Revision 0, (December, 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 sepsrate labeled containers.
NOTE:
In case of serious contamination around a wound, rapid re-moval 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 scrub thoroughly and repeatedly with intermittent 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.
Degontaminate area surrounding orifices; 3.
Gently clean orifices using wetted swabs; 4.
If nose swab indicates significsot radioactivity in nasal cavity, use nasal blows and nasal irrigation:
5.
Collect all materials used ano 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
Procedure No, M1-18 Revision 0, (December, 1985)
ATTACHMENT E (Continued) a E.
Decontamination of Wounds (Continued) 4.
Depending on surface and depth of wound, irrigate wound with sterile saline, dab with geuze pads soaked in sterile saline to cleanse wound; collect all materials used and place in separate labeled containers; 5.
Remove obviously necrotic and devitalized tissue surgically; I
keep all tissue specimens removed; 6.
Repeatedly monitor wound; record results on patient record aheet; 7.
If contamination p9rs!:t:, 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 s
patient are as follows:
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 j
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.);
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Procedure No. M1-18 Revision 0, (December, 1985)
ATTACHMENT __E (Continued)
Procedures for Sample Taking (Continued) 3.
In case of neutron irradiation... materials in which neutron induced radioactivity may be present (gold rings, buttons, hair, nail clippings);
4.
Hematological specimens (whole blood in heparinized, oxalated and uncoated tubes; blood smears).
As the analysis of radioactive samples with regard to their composition is only possibic 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 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, and smear a skin area of about 100 cm2 (4n x 4-),
gf 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 place in envelope. Alternatively, tape may be used to remove contaminants for later examination.
2.
Take samples of nails, hair and collect metallic objects (rings, watches, glasses, belt buckles, etc.).
E-7
_-_________________.____.___________________.._._._______.______.______-m_.___-____.__________,_______________________.______-_____..._.__._m_.__________.m__
Procedure No. M1-18 Revision 0, (December, 1985) l ATTACHMENT E (Continued)
Sample Taking Techniques and Indications (Continued)
External Conte.mination (Continued) 3.
Wound Samples: use either one of the following methods:
- for large wounds with visible blood or wound fluid --
obtain a few cc using an eye dropper or syringe; transfer to bottle and label;
- for superficial wounds -- rub 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.
i Internal Contamination 1.
Body Orifices: wet Q-tip with a few drops of water; swab and store in waterproof envelope and label; 4
2.
In all cases where internal contamination is expected: collect 4
urine and feces in containers supplied, and record time of
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voiding.
External Exposure:
In all cases where a total body exposure is suspected:
1.
Obta~in 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.
E-8 G
e Procedure No. M1-18
. Revision 0, (December, 1985)
ATTACIfMENT E (Continued)
Sample Taking Techniques and Indications (Continued)
External Exposure (Continued) i NOTE: Return bloassay samples to kit.
With any specimens necessary to g
the emergency medical treatment of the patient which are obtained prior to completion of decontamination and are to be processed in 4
l the hospital _ laboratory, be sure to clean the outside of the specimen container (test tube, etc.) and have i t surveyed before i
handing it out to the Buffer Zone Attendant.
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e Procedure No, M1-18 Revision 0, (December, 1985)
ATTACHMENT F PARTS LIST FOR DECONTAMINATION AND SAMPLE TAKING KITS
t Procedure No. M1-18 Revision 0, (December, 1985)
ATTACHMENT F DECONTAMINATION KIT CONTENTS Skin Decontaminants Quantity Betadine 1
Turco 1
Phischex 1
Clorox 1
Corn Meal 1
Tide 1
Shampoo 1
Wound (Or Skin's Decontaminants Saline 2
E-Z Preps 10 Hydrogen Peroxide 1
Materials for Decontamination E-2 Scrubs 10 Towels 10 Gauze Pads 15 Q-Tips 15 Surgical Gloves 10 Solution Bowls 2
Irrigation Syringe 1
Shave Prep Kit 1
F-1 1
Procedure No. M1-18 Revision 0, (December, 1985)
ATTACHMENT F (Continued)
DECONTAMINATION KIT CONTENTS (Continued)
Miset11aneous Items guantity Procedure for Decontamination 1
Skin Cream 1
Colloidin 1
Steri Drape 1
Marker 1
Pen 1
Clipper 1
Surgical Tape 1
Plastic Bass 10 F-2
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J Procedure No. M1-18 Revision O.
(December, 1985) 4 ATTACHMENT F (Continued) i SAMPI.E TAKING KIT CONTENTS Sample Type Sampling Instrumen_t Ouantity Nasal swabs 4
l Aural swabs 4
1 Oral swabs 4
Skin Folds swabs 4
Swipes swabs 4
Swipes Nucon Smear.
25 slots Hair small container 4
Nails small container 4
l 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 ce plastic container 1
Feces fecal container 2
1
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Wound Exudate swabs 4
eyedropper & bottle 2
i Tissue
. containers 2 small f
2 medium j;
Vomitus fecal container 2
Irrigation Fluids 100 ce plastic bottle 2
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Procedure No. M1-18 Revision O.
(December, 1985)
ATTACllMENT F (Continued)
SAMPLE TAKING KIT CONTENTS (Continued)
Miscellaneous Items _
Quantity Envelopes 10 Labels 50 Pens 1 grease I writing Scissors 1
Tweezers 1
Clippers 1
F-4
i Procedure No. M1-18 Revision 0, (Decembor, 1985)
ATTACHMENT C REA STORED SUPPLIES & EQUIPMENT
l Procedure No. M1-18 Revision 0, (December, 1985)
ATTACHMENT C REA STORED SUPPLIES & EQUIPMENT MONTGOMERY HOSPITAL QUANTITY ITEM 1
Decontarination Table Top w/ splash guard, stretcher splash guard, stretcher insert (2) 15-gallon poly vinyl water containers 2
Contaminated waste container 35-gallon with mobile base i
1 Decontamination Kit 1
Bioassay Sample Kit 1
Mobile Storage Cart, with worktop and storage bin built to contain items listed 1
Lead container, for high activity specimens 10 Masking tape, 2" width 1
Radiation warning rope, cut to fit REA 10 Radiation warning signs 4
10 Plastic trash can liners, 35-gallon with warning sign 30 Radiation sign inserts 1
Flexible with Adjustable showerhead 2
Step of f pads, laminated (30' x 48')
2 Laminated Accident Poster 1
Clipboard with Body Charts 4
G-1 i
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Procediare No. M1-18 Revision 0, (December, 1985)
ATTACHMENT C (Continued)
RFA STORED SUPPLIES & EQUIPMENT OUANTITY ITEM 4
Stanchions, metal 10 Magnetic holders for warning rope / signs 25 Protective clothing packs 100 sq yd Herculite (pre-cut to fit REA) Yellow, White 15 sets Dosimetry, 0-500 m/R 1
Count Rate Meter, Eberline Model E-140N 1
Geiger Counter, Victorcen
,e G-2
Procedure No. M1-18 Revision 0, (December, 1985) l 1
1 4
ATTACHMENT H RADIATION EMERGENCY TELEPHONE DIRECTORY 8
I
Procedure Noe M1-18 Revision 0, (December, 1985)
I ATTACHMENT H i
RADIATION EMERGENCY TELEPHONE DIRECTORY Montgomery Hospital Main. Switchboard (215) 270-2000
$^
TO BE PROVIDED i
i Philadelphia Electric Company - Limerick Generating Station i
Switchboard (215) 327-1200 i
Shift Clerk - Control Room (215) 327-1200, Ext. 2126 Security Leader (215) 327-1200, Ert. 2622 (215) 327-2918 Verification Number-Radiation Management Corporation s
i EMERGENCIES (215) 243-2990 (24 hrs.)
(215) 841-5141 (24 hrs.)
GENERAL BUSINESS (Philadelphia)
(215) 243-2950 i
GENERAL BUSINESS (Chicago)
(312) 310-8650 l
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ATTACHMENT I LOCATION OF MANUALS
o - 1 Procedure No, M1-18 Revision O.
(December, 1985)
ATTACHMENT I LOCATION OF' MANUALS Copy Number Location Radiation Management Corporation 1
Philadelphia Office Montgomery Hospital TO BE PROVIDED Limerick Generating Station Site EP Coordinator Technical Support Center Control Room Philadelphia Electric Company Emergency Off-Site Facility Medical Director Director, Emergency. Planning Electric Production QA Superintendent Director, Radiation Protection I-1 1,-
a Procedure No. M1-18 Revision 0,
( Dec t.mbe r, 1985)
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THE IIANDLING AND TREAIMENT OF A RADIOACTIVELY CONTAMINATED AND INJURED PATIENT BY EMERGENCY DEPARTMENT PHYSICIANS AND NURSES PLAN OF INSTRUCTION TOPIC TIME PURPOSE METff0D INTRODUCTION 15 minutes To introduce Radiation o Slide and Management Corporation.
Lecture provide an overview of Presentation the course and explain the need for special procedures when dealing with an injured and contaminated patient.
IONIZING RADIATION 60 minutes To define ionizing radia-o Slide and BIOLOGY tion, terminology.
Lecture background radiation.
Presentation protective actions and the detection and measurement of radiation.
BREAK 15 minutes CLASSIFICATION OF 45 minutes To discuss the biological o Slide and RADIATION ACCIDENTS cffects of radiation Lecture AND THE MEDICAL exposure, to present the Presentation j
SIGNIFICANCE OF types of radiation injuries RADIATION EXPOSURE and the medical aspects of each type of injury.
EREAK 15 minutes a
HOSPITAL RESPONSE 30 minutes To present an overview of o Videotape TO THE RADIATION requirements and to review ACCIDENT VICTIM types of radiation injuries, i
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OF RESPONSE:
used in biological and lecture ASSESSMENT AND radiological assessment of presen-DECONTAMINATION the radiation accident tation i
victim and to explain
+
procedures for decontami-nation of wounds and intact i
skin.
1 MONTCOMERY HOSPITAL 60 minutes To demonstrate the procedures o Participatory PROCEDURES that will be used at Mont-Demonstration gomery Hospital including j
REA set up, the use of pro-
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tective clothing and dosimetry and the sequence of steps in j
the management of contaminated patients.
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MONTGOMERY HOSPITAL RADIATION EMERGENCY MEDICAL SUPPLIES AND EQUIPMENT QUANTITY ITEM
> ',,. ),.
l' Decentamination Table Top w/ splash guard, stretcher splash guard, stretcher insert (2) 15-gallon poly vinyl water containers 2
C6ntaminated waste container 35-gallon with mabile base
.,i 1
Decbntamination Kit 1
Bioassay Sample Kit 1
Mobile Storage Cart, with worktop and storage
. bin' built to contain items listed 1
-Lead Container, for high activity specimens 10 Masking tape, 2" width 1
Radiation warning rope, cut to fit REA 10 Radiation warning signs s
10 Plastic trash can liners, 35-gallon with warning sign 30 Radiation sign inserts 1
Flexible with Adjustable showerhead
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2 Step off pads, laminated (30' x 48')
i r
i 2
' Laminated Accident Poster 1
Clipboard with Body Charts 4
Stanchions, metal 10 Magnetic holders for warning rope / signs 25 protective clothing packs 100 sq yd Herculite (pre-cut to fit REA) Yellow. White 15 sets Dosimetry. 0-500 m/R i
1 Count Rate Meter, Eberline Model E-140N f,
Geiger Counter, Victoreen 1
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