ML20148G839
| ML20148G839 | |
| Person / Time | |
|---|---|
| Site: | Yankee Rowe |
| Issue date: | 12/10/1975 |
| From: | RADIATION MANAGEMENT CORP. (RMC) |
| To: | |
| Shared Package | |
| ML20148G833 | List: |
| References | |
| PROC-751210, NUDOCS 8011140173 | |
| Download: ML20148G839 (40) | |
Text
iMlal!0!!
' ~'
rme -
~~~e,"-
- < ~, -
!UIE00m8DI numnmm 00f00"d100 i
v Medical Management of Radiation Accidents PLANT AND HOSPITAL PROCEDURES MANUAL for YANKEE ROWE h"JCLEAR POWER STATION AND Ndim! ADAMS REGIONAL HOSPITAL This manual has been prepared by Radiation Management Corporation using documents and data supplied by the plant, the supporting hospital, and RMC, Revisions will be distributed by RMC as they become necessary by supplying new sheets or sections.
O Date of latest revision:
DEC 101975 so n14,o /73
i i.
t t
1 8
4 G
0 t.*
DECONTAMINATION ATID TREATMENT OF THE RADI0 ACTIVELY CONTAMINATED PATIENT AT NORTH ADAMS REGIO!1AL HOSPITAL S
l l
w go i
e
~
PrC011TAMlllAT10ft AtlD TREATMENT i.
OF THE RADI0 ACTIVELY C011TAMIflATED PATIEllT AT NORTH ADAMS REGIO!1AL HOSPTIAL TABLE OF CONTENTS TITLE PAGE NO.
A.
PURPOSE 1
B.
REFERENCES 2
C.
PREREQUISITES 2
1.
Alert /flotifications 2
2.
Prior Action at !!uclear Power Station 2
D.
PRECAUTI0ils 3
E.
LIMITAT10flS Afl0 AC' IONS 4
F.
PROCEDURE 4
1.
Notification 4
2.
Emergency Room Radiation Team 5
3.
Maintenance 5
4.
Housekeeping 6
5.
Control Point Attend' ant's Duties 6
6.
Attending Physi.cian's Duties 6
7.
Nuclear Station llealth Physics Personnel 8
8.
%diation Management Corporation 9
G.
CHECK LIST - ilone 9
H.
TECH. SPEC. REFERENCES - ilone 9
.m POOR ORIGINAL 0
3 ATTACHMENTS AMBULAf4CE ACCESS ROUTE TO REA DIAGRAM I DIAGRAM II PLAft VIEW 0F REA PROCEDURE FOR THE USE OF PROTECTIVE CLOTHING Af1D 00SIllETERS APPENDIX A PROCEDURE FOR PATIENT DEC0!1TAMINATION AND SAMPLE TAKING KITS APPENDIX B PARTS LIST FOR DECONTAMItlATION AND SAMPLE KITS APPENDIX C INVEllTORY 0F RADIATION EftERGENCY AREA SUPPLIES AND EQUIPMEllT APPENDIX D RADIATION EMERGEliCY TELEPH0flE DIRECTORY APPENDIX E LOCATION OF MAtlUALS APPENDIX F DOSIMETRY LOGS APPENDIX G O
b u
NOR ORIGINAL
~
t t
9 t
DECnNTAMINATION & TREETMEt1T OF'THE RADII,4TIVELY CONTAMIilATED PATIENT At NORTH ADAMS REGIONAL HOSPTIAL A.
PURPOSE 1.
By agreement between Yankee Atomic Electric Company and North Adams Regional Hospital, personnel at Yankee Rowe sustaining injuries from ionizing radiation or injuries complicated by radiation exposure or radioactive contamination will be provided care and treatment at North Adams Regional 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 be admitted, decontaminated and treated in accordance with these procedures.
3.
The purpose of these procedures is to assure the radiation protection of the hospital staff, other patients and visitors during admission and treatment of the radioactively contaminated patient.
The hospital's protection program starts at the nuclear station with an alert or warning telephone call to the hospital informing us that there has been a radiation accident, and one or more injured and contaminated persons may equire treatment.
On receipt of such a call, our staff will prepare to admit the patient (s) through our Radiation Emergency Area (REA) that has been established in the Cla.rk House. The M m will be set-up in accordance with the directions given in Section F, " Procedure".
4.
Hospital personnel will utilize protective clothing and personnel radiation dosimeters in accordar.ce with directions contained in Appendix A,
" Procedure for the Use of Protective Clothing and Dosimeters".
Such J
I 1
..v A
Continued) contamination of the patient as may be required, and the collection of contamination samples will follow the directions given in Appendix B,
" Procedures for Patient Decontamination and Sample Taking".
5.
A radiation accident medical consultant organization, RMC has been retained by Yankee Atomic Electric Company to provide radiation medicine and health physics consultation.
RMC services are available '
i 24-hours a day.
B.
REFERENCES - None C.
PREREQUISITES 1.
Alert /NotifiCdtion As soon as it has been established by the nuclear power station personnel that a patient may be referred to the hospital for treatment, an alert call to this effect will be given.
As soon as it has been established that admission to the hospital will be required, station personnel will notify the hospital.
The alert and notification calls will be directed to the Hospital Switchboard Operator, 413-663-3701 (see paragraph r.1 below).
2 '.
Prior Action at Nuclear Power Station Before sending the patient (s) to the hospital, the nuclear station personnel will execute the following procedures:
Administer first-aid Consult with the Nuclear Station Coordinating Physician Decontaminate the patient (s) to an extent compatible with injuries
(,.
.m
,.a
6 0
g PREREQUISITES (Continu$ )'
1 I
. Inform the hospital of expected arrival time j
1
. Describe the apparent injuries
. Assign station personnel qualified in rad'iation protection procedurestoaccompanythepatient(s).
l
[
D.
PRECAUTIONS There are three major types of radiation exposure which may cause injury:
- 1) penetrating radiation exposure from a source external to the body
[
i (gamma. rays, neutrons);
j 2) internal exposure to radionuclides by ingestion, inhalation, or through a skin break;
- t 3) skin and superficial tissue exposure by contamination of the surface
{
.. 5-of the body with radioactive materials.
i 1
These three types of radiation exposure may occur together.
{
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 i
patient will harm the attendant.
Equally without hazard to others is the patient who has received an overdose
{
i of radionuclides by ingestion or inhalation.
He is no more hazardous than j
the patient who has been given diagnostic radioisotopes in the hospital clinic.
l However, the individual whose clothing, skin and/or wounds are contaminated f
with radioactive material may present a radiation hazard to attending personnel in the absence of adequate procedures to prevent the spread of the contaminant, or control the radiation exposure in the event of radioactive
{
i shrapnel wound.
Since radiation injurie's are not immediately life-threatening,
\\ i
... I
D.'PRECkUTI0!lS(Continued) primary attention should always be directed to traumatic life-threatening injuries, e.g. severe bleeding, airway obstruction, shock.
Concomitantly, or as soon as possible, the patient should be decontaminated.
If practical, the condition of an injured person who is als.o contaminated will be discussed on the phone with the Nuclear Power Station Attending Physician before he is sent to the hospital.
In all instances, the hospita'l will be given as 'nuch warning as possible of the impending arrival of the patient.
.E.
LIfilTATIONS AND ACTIONS 1.
All decontamination of hospital personnel, equipment, and f acilities shall be supervised by Nuclear Power Station personnel.
~
2.
North Adams Regional Hospital is the only treatment facility where radioactively contaminated accident casualties from Yankee Powe Station may be treated without explicit approval of Yankee Atomic Electrid Co.
F.
PROCEDURE 1.
Notification In accordance with paragraph C.1, Nuclear Power Station personnel will alert the hospital by calling the Hospital Senior flursing Supervisor.
It will be the responsibility of the Senior Nursing Supervisor to take the following action:
a) Obtain the following information from the caller:
1.
How many patients will be sent to North Adams Regional Hospital?
2.
Is each patient contaminated?
. s
(;
Fo PROCEDURE (Continued) i 1
3 What are their injuries?
4.
What is the expected time of arrival at the hospital?
5.
Will special equipment be required 'by hospital personnel?
If so, specify.
6..
Has the Nuclear Power Station Physician been notified?
b) The Switchboard Operator wil1 call a Code Magenta, notify the following and brief them:
1.
Supervisor of Nurses 2.
Williamstown Medical Associates, 413-458-8182 2.
Emergency Room Radiation Team Personnel working in the Emergency Room will form a Radiation Team and be responsible for the following:
c) Prepare medical and nursing personnel for entry into a contaminatedarea(SeeAppendixA, Procedure for the Use.of ProtectiveClothingandDosimeters).
b) Open and prepare the Radiation Emergency Area - Housekeeping.
3.
Maintenance a) Make sure waste disposal cans with plastic liners are available for use in the treatment room.
b) Be available to assist Housekeeping in area, if needed.
c)
Erect the rope barriers separating the Buffer Zone from the l
Uncontrolled Area.
d)
Post barriers with: " CAUTION - RADIATI0fl AREA - RADI0 ACTIVE MATERIALS AUTHORIZED ENTRY ONLY" signs.
P00R ORIGINAL e
.m
.m._,
(_
F.
PROCEDURE-(Continued) j i
1 3'
Maintenance (Continued) e) Cover the walls of the treatment room with plastic and seal with masking tape (when specified.by the nut:1 ear power station personnel).
4.-
Housekeeping The Housekeeping Manager or his designee will be responsible for
]
supplying additional material from his department.
l 5.
Control Point' Attendant's Duties a) Restrict access to personnel _ authorized entry by.the attending f
physician or the nurse-in-charge, b) Assure that personnel entering the REA are wearing protective clothing and personnel dosimeters.
c) Maintain a record showing each person entering REA, personnel dosimeter number and time of ingress and egress from REA.
d) Assure that no person or thing is allowed to leave the REA (after the radioactively contaminated patient is admitted) until it has been monitored by nuclear station personnel and f.ound to be " clean", i.e., free of detectable radioactive contamination.
e) Assist nurse-in-charge and attending physician in the set-up of the REA.
6.
Attending Physician's Duties a) Assure that the Radiation Emergenry Area is set-up for admission of a radioactively contaminated patient.
b) Assure that hospital personnel are wearing protective clothing and personnel dosimeters.. _
.m
'F.
PROCEDURE (Continued) 6.
Attending Physician's Duties _ (Continued) c) Upon arrival of the patient:
1.', Question the accompanying nuc1 car station personnel concerning the patient's contamination status and precautions that should be taken by the hospital staff.
2.
Administer emergency treatment.
3.
Decontaminate the patient and collect samples of the contaminant in accordance with Appendix B of this procedure.
4.
Following decontamination and emergency treatment, transfer the patient from the REA to the appropriate section of the hospital for care or further treatment.
(a)
Provide pathway of freshly laid kraft paper from the Control Point to the doorway of the treatment room.
(b) Wheel a stretcher across this pathway to locatioc immediately adjacent to the doorway of the treatment room.
(c) Transfer the patient to the " clean" stretcter by lif ting him on a "cican" sheet, or by utilizing the stretcher insert.
(d) Monitor the patient and stretcher in the Buffer Zone to assure that they did not become contaminated in the transfer.
Decontaminate, if required, and move patient into the " clean" area of the hospital.
d) When the patient has left the REA:
1.
Assure that all involved personnel are monitored and decontaminated if necessary prior to leaving the REA.
2.
Assure that the nuclear power station personnel are provided such assistance as they may need to monitor and decontaminate the REA and to restore it to operational condition.,
.l
(
?.
F.
PROCEDURE (Continued) 10TE:
Everything and everybody entering the controlled area must stay there until properly monitored, decontaminated, and cicared through Control Point.
- 7.. Nuclear Station Health Physics Personnel
.i. Accompany all referred casco with surface radioactive contamination to hospital; 2.
Direct vehicle to hospital entrance of Radiation Emergency Area;-
3.
Control radiation exposure at hospital:
a.
Determine adequacy of traffic control in emergency area; b.
Supervise and regulate protection of involved personnel throughout the emergency; c.
Collect pocket dosimeters, monitor, and evaluate personnel exposure upon completion of emergency; d.
Collect used protective clothing and all other contaminated material and wastes.
Package and return to the station for laundering or disposal; c.
Monitor equipment and property af ter the emergency; f.
Decontaminate equipment and hospital areas as required; g.
Re-open the Radiation Emergency Area when "cican".
4.
Assist in the decontamination of the patient when treatment of injury permits as determined by M.D.
5.
Save and label all specimens of urine, vomitus, feces, blood, tissue and metals from the patient until their use in radiation evaluation has been completed.
6.
Record radiation survey findings of personnel and property.
7.
Accompany to hospital all non-contaminated cases referred for radiation injury.
a.
Direct to accident ward; b.
Assist M.D. with accident history, estimate of radiation ' xposure, e
and bioassay studies.
-:8-
(
i i
1 1
l i
1
{
i DIAGRAM I TO DE SUPPLIED I
AT A LATER DATE.
J 4
S e
l t
G
.,,._m., _ _ _ _
.-.m m
> Patient
>g
- 4..x
/
s'
^!
Covered with Vinyl Tile 4
- P 4
y.-
ZA
)
y p
.c.
A m
4 k
al
[
Medical Personnel R
y Deci camination f -
\\A A
Arca Y
o E
j y
g U
.T A
Monitoring Station Covered with Vinyl Tile
- 1.
Y 4
~
Medical Personnel Assembly Arca e
NORTH ADAMS REGIONA o
Not to Scale.
Ti pg DIAGRAti 11 g. _.
.c j-
APPENDIX A
..a PROCEDURES FOR THE USE OF PROTECTIVE Cl.0THIflG
~
AND 00SIMETERS I
O
(
1 O
Appendix A PROCEDURES FOR THE USE OF PROTECTIVE CLOTHIt!G A!!D DOSmr7Ea3 A.
To prevent personnel from becoming contaminated with radioactive material, protective clothing will be issued at the Control Point.
B.
Two kinds of protective clothing are available:
1.
Standard Protective Clothing, essentially consisting of the same items normally used by surgeons in the operating room, i.e. a scrub suit, surgical gown, latex 916ves, and a surgical mask and cap, augmented by shoc covers and a vinyl apron:
2.
Full protective clothing, consisting of some or all of the following items:
coveralls, full rubber suit, hood, protective footwear and rubber gloves.
C.
Conditions requiring protective clothing 1.
All work past the Control Point requires protective clothing, independent of the degree of contamination present on the patient or his clothing.
a.
Standard Protective clothing will suffice in all cases _where gross decontamination has been performed (i.e. wnere very little ' loose" contamination is present) or where the contamination is confined to a relatively small area; b.
Fullyrotective clothing is only necessary when the patient has a relatively large amount of removable contamination on body and/or clothing.
2.
Without specific instructions to the contrary, standard 2rotective clothing may be assumed to suffice. In case the plant health physicist, accompanying the patient, judges the use of full protective clothing necessary, mask, gown, and apron will be removed, coveralls put on over the scrub suit, and hood, rubber gloves, and shoe protectors.
donned to replace the items removed.
3.
For complete protection, taping of full protective clothing around the hood, and at the wrists and ankles may be required. For this purpose, 3-inch wide gray tape is available.
Taping will only be done upon instructions by the health physicist.
( -
~
i)
D.
Removing contaminated protective clothing 1.
Upon. completion of their activities in the contamination and treatment room, personnel will proceed to the rope between the contaminated. area and the buffer zone (See Diagram II), take off the outer layer of the protective clothing and deposit garments in a plastic laundry bag, in the following order:
a.
remove tape and hood, if any; b.
remove apror) 'and gown, or ' coveralls, turn 1ng them inside out; c.
remove shoe covers, one at a' time, stepping out of the contaminated
)
~
area - over the rope - with the uncovered shoe; d.
remove gloves, mask, and cap.
2.
After removal of the outer layer, personnel proceed to the Control Point (without crossing the rope between the buffer zone and the -
uncontrolled hospital area) to have their dosimeters removed and to be monitored for any contamination.
E.
Clearance procedures 1.
In case no contamination is found, personnel may proceed to the change area and put on their normal clothing. After a final check at the Control Point, they will be cleared to enter the uncontrolled hospital area.
2.
In case persons are found to be contaminated, they will take a shower, be monitored again, and, if free from contamination, be supplied with disposable garments; then proceed as described above.
F.
Use of dosimeters 1.
Dosimeters will be supplied at the Control Point to all personnel entering the Radiation Emergency Area 2.
Dosimeters are of three types:
- a.. Direct reading dosimeters (" pen-dosimeters"), which are supplied f
to all personnel; b.
Badge dosimeters (TLD type), also supplied to all personnel; c.
Ring dosimeters (TLD's), which are only supplied to surgeons (and their assistants, if any) in case they have to remove highly l
radioactive foreigh bodies.
i l
(
- l 3.
Dosimeters are to be worn:
a.
Above the sternum, clipped to the scrub suit (pen and badge dosimeters) i.e. under the outer layer of the protective clothing.
b.
On the ring finger of the right and left hand under the glove l
(ring dosimeters).
4.
Upon leaving the Radiation Emergency Area, the wearer should surrender his dosimeters to the Control Point attendant, who will record the reading of the p",en dosimeter and retain the TLD dosimeters for later
~
processing by Radiation Management Corporation.
.5.
The Control Point attendant must assure that the records clearly show the serial number of each dosimeter worn by each individual who occupied the Radiation Emergency Area and duration of time each individual spent in the REA.
e f
4 e
4..
A APPENDIX B l
)
PROCEDURES FOR PATIENT DECO llTAMIflATI0tl AND i
SAMPLE TAK1tlG 0
6 n
i i
FDDRORi'llNAL i
(
7 I
I Appendix B PROCEDURES FOR PATIENT DECONTAMIflATION AND SAMPLE TAKING A.
General These procedures cover the use of the RMC 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.
Identical kits have been furnished to the Nuclear Power Plant and its supporting hospital.
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.
Appendix C 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.
Appendix C also contains a copy of " Patient Radiation and Medical Sta,tus Record Sheet".
This form should be used to record essential data on the patient's medical and radiation status.
It should be completed at the Nuclear Power Station and sent with the patient to the hosp. ital.
Several copies of this form are contained in each kit.
B.
Patient Decontamination Procedures 1.
Principles a.
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; (3) to protect attending personnel from becoming contaminated themselves or (in extreme cases) from being exposed to a source of radiation.
Pa2R ORialNAL
(
- 2 '-
0 b.
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.
c.
Decontamination is essentially the physical removal of radioact've dirt from the skin, wounds, or body orifices.
Most decontaminants contain detergents or other chemical agents to facilitate this removal.
Therefore, most decontaminants are suitable for decon-tamination of. the intact skin only, i.e., are not appropriate for wound cleansing or irrigation of body orifices.
d.
Decontamination is performed:
from the highest level of contamination to the lowest; starting with the simplest procedure (e.g., soap and water) to more complicated procedures; with due regard to contamination of wounds, body orifices, etc.
(see below for specific guidelines),
e.
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 below).
2.
Measures to be taken before decontamination a.
Assuming that gross decontamination has been performed at the fluclear Power Station, it can be expected that the residuc, contamina-j tion is minor, and/or that serious contamination is localized, e.g.
around and in a wound.
Before decontamination, the following steps s'iould be taken:
(1) judge whether the patient's condition requires immediate intervention; if so, proceed, covering the contaminated area with a plastic drape or a towel; (2) obtain a briefing from the liuclear Power Station health physicist as to the contamination status of the patient, and as to the j
specific measures to be taken by attending personnel with regard to their protection.
l
(.
<3-(3) monitor the patient with the radiation survey instrument by scanning the entire body (holding the probe about 2 inches from the skin), and record the findings on the PATIEttT STATUS RECORD SHEET; decide in which order skin decontamination shall be performed; (4)' inspect wounds, inquire about their decontamination at the fluclear Power Station, and decide whether further wound decontamination or treatment can safely be postponed until completion of skin decontamination; (5) make a decis ka as to whether certain sampics should be taken (see paragraph C for further details).
b.
In case no decontaminat. ion has been performed at the flucicar power Station (most likely because of an urgent need for emergency surgical treatment):
(1) perform a gross decontamination by removing all clothing and obvious dirt and debris; if inmediate intervention is necessary, cover the contaminated area with a plastic drape and proceed; (2) at the same time: obtain a br:efing from the fluclear Power Station health physicist as to the measures to be taken by attending personnel with regard to their protection:
(3) afterthe emergency treatment; proceed with the applicabic steps described under 2a(2) to (5) above.
3.
Decontamination techniques a.
General Two general rules apply to the performance of decontamination:
(1) check the effectiveness of the technique appiied by monitoring periodically; (2) avoid the spread of radioactive materials from th'e area being de-contaminated to areas of lesser contamination by covering the adjacent area.
Except when prohibitive degrees of contamination are present on/in any of the locations listed below, decontamination is performed in the following order:
.r _ _ _-_,_ _-
E E
^
,j
[.
g (1). wounds and adjacent skin; P
(2) body orifices and adjacent skin; l
(3) other skin areas.
l b.
Decontamination 6f wounds
'(1) use aperture drape (DW5) (see code in Parts List) to isolate the contaminated area; (2) take sample (see paragraph C2 a);
(3) decontaminate skin adjacent to wound as described below; (4) depending on surface and depth of wound, irrigate wound with sterile saline (use DW3, DW4, and DW8), dab with gauze j
pads and sterile saline (use DW3, DW8, DW1, and DW6), or
{
use applicators (DW7) to cleanse wound; collect all materials-used, and place. in labeled containers;
{
(5) remove obviously necrotic and devitalized tissue _ surgically; l
~
)
keep all tissue specimens removed (see paragraph C)-
(6)' monitor wound; record result on DM7; (7) if contamination persists - consult With RMC to determine further course of action; (8) if wound clean - treat-wound as indicated.
I c.
Decontamination of body orifices (1) take samples of activity in nares, car canals, and other orifices as indicated (see paragraph C2 a);
j (2) decontaminate area surrounding orifices as described below; I
(3) gently clean orifice using wetted swabs (DW7 or SWN2);
(4) if nose swab indicates significant radioactivity in nasal cavity, irrigate (DN1 and DN2);
j (5) c611ect all materials used, and label containers.
d.
Decontamination of skin (1) take smear sample of area (see paragraph C2 a);
(2) protect adjacent area by covering with plastic drape or towels; (3) cleanse skin area:
l..
1 around wounds and orifices:'
l tepid water, using large absorbent balls (DSK1); cover entire contaminated surface with a good latner, repeatedly
.x
,,.r-.-
~. _. -,.,..,,,.. _
9
(..
_5_
renewing cotton balls (discard in DSK4); remove t.
~
1ather after 2:3 minutes by wiping repeatedly with wetted cotton balls; monitor; record result on DM7; other skin areas: wash thoroughly with Turco decon soap (DSK8)andtepidwater,usingeithercottonballs(DSKl),
pre-op sponges (DSK5), or hand brushes (DSK6); cover
- area with a good lather; rinse off after 2-3 minutes with running water; monitor; record result on DM7.
(4) if contamination persists: repeat step (3) once; (5) if contamination still persists: try gentle application of clorox (DSK9) or hydrogen peroxide (DW9) l10TE:{ avoid any of these entering wound or body opc616gs); repeat a few times using new cotton balls; remove decontaminants with water; monitor; record result on DM7; (6) after complete decontamination: dry skin and apply Nivea cream (DM2)
(7) if residual cont =inaticn is present: consult with plant health physicist to decide whether further efforts are indicated (consult with RMC if necessary); if it is decided to accept residual contamination, dry the skin and apply collodion (DM1), mark area involved (DM8); record on DM7; (8) collect all materials used and label containers.
NOTES:
in case of serious contamination around a wound, rapid removal of the bulk of radioactivity can be obtained by shaving (use DM4) the adjacent skin; in case of serious contamination of hair, or under nails: clip (use DM3 or DMS).
C.
Procedures for Sample Taking 1.
Principl es_
a.
The objectives of collecting specimens from a radiation accident victim are:
PDDR DRIGINAL
s (l)' 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;
' (3).to supply information' on the biological injury inflicted by the irradiation.
b.
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, stools, sputum,etc.);
(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. leukocyte counts).
~
c.
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.).
d.
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.
2.
Sample taking techniaues and indications a.
External contamination Before decontamination, the following samples shall be obtained:
(1) skin smears:
use SSK1 smear pads, moisten with a few drops of water, and smear a skin area of about 100 cm (4x4$y,),
2 if possible, by allowing sticky side of the smear to adhere to gloves, and rubbing the smear pad over the surface to be
l g-7_
sampled; place smear on record paper, record location and time, and area smeared if other than 2
100 cm ;
'(2) wound samples: use either one of the following methods:
large wounds with visible blood or wound fluid: obtain a few cc using dropper from swr 13; transfer to bottle and 1abel; superficial wounds: rub gently with cotton swab Swill, return to tube, label; wounds with visible dirt or debris: remove with applicator Swill or use tweezers, and transfer sample
~
to small glass vial SSSl; label.
b.
Internal cor>tamination (1) body orifices: wet Q-tip swr 12 with a few drops of water, swab, store in water-proof envelope SW'?4, label; (2) in all cases where internal contamination is suspected:
collect all urine and feces in containers supplied (SF3 and SFl respectively), record time of voiding.
c.
External exposure In all cases wher,e a whole body dose of more than 10 rad is suspected:
(1) obtain a blood smeat for differentiation; (2) obtain a leukocyte count; (3) obtain 30 ml o? blood in vacutainers SB1, SB2, and SB3, using 584 and 585.
Record time these samples were taken.
i POOR ORIGINAL
I s
L, i
l i
?
t l
I I
4 t
i APPEllDIX C
[
i i
t PARTS LIST FOR DEC0i1TAMINAT10f4 AND SAMPLE TAKING KITS Ii 9
P 8
i r
t s
o 9
1 I
i o
i
?
l r
6 i
f s
i i
F 6
f i
, 'DECONIb1INATION KIT Parts I st/ instructions for Use Code:
- 1. - Skin Decontmaination yellow round labels marked:
(a) Utensils:
Absorbent balls, extra largo 100 DSK1 Sponge - holding forceps 1
DSK2 Plastic beaker, large (to discard used sponges) 2 DSK4 Pre-op spong~
(for'large area deconta:nination) 6 DSKS Stirgical hand brushes (for' hands /fect decontc:aination)
DSK6 Wash bottle (to hold water for decentamination) 1 DSK7 (b) Deconta ainants
'IURCO decen soap, bottics (f r first decon effort, general) 2 DSK8 (see 7structicas
~
Clorox, bottic
.a bottle)
(for second decen effort) 2 DSK9 2.
Wound Cleanint (a) Utensils:
Sterile gauze pads, 4x4-inch, in box 100 DW1 Surgical gloves, assorted sizes sterile, pair S
DW2
. Solution bowl, plastic 1
DW3 P3ungcricss syringes, 50 cc, sterile 1
DN4 Cotton tipped applicators 25 DW7 (b) Cleansing agents:
Saline solutions, normal stori3c, bottic 1
DNS
!!ydrogen peroxide, 3% solution i
bottle 1
DW9 o POOR ORIGINAL l
'~
' DECd.Vr/OlI ?\\ TION KIT (Conti-d)
I
- 3. Miscellaneous materials Niveacream, jar (apply on dry skin after complete decon) 1 Bil Prep Kit (for clipping and shaving) 1 IN2 Nail clippers, pair 1
E13 Scissors, heavy duty,' HARE, paramedic 1
2 14 New Form Patient Radiation and Medical Status Record Sheets (for recording essential data on patients' medical and radiation status) 5 3 15 Plastic bags, assorunent (to hold decon materials after use) 1 2 16 Tags,adth wire (to indicate centents of container and bags) 10 R17 Tissue paper, box 1
D.'18 Notebook 1
E19 Pencils 5
DM10 j
1 i
p l
MDR ORIGINAL i
2 i
1
\\
SMlPLE TAKING KIT Parts list / instructions for use
)
Code:
i;rcen round 1.
Blood Samp1.
r labels marked:
Vacutainers, :aparinized, 10 m1, sterile _
.6 SBl
, green stopper Vacutainers, uncoated,-
1 6
SB2
, red stopper 10 m1, sterile Vacutainers, oxalated, 10 m1, sterile 6
SB3
, gray stopper Necala-holder combination, sterile 12 SB4 Alcohol wipes, sterile, pre-packaged 12 SBS' 2.
t'ound F'1uid, Nose Swabs Cotton tipped applicators, in test tube, sterile ShN1 Envelopes, (for storage of j
nose swabs)
SNN4 Tissue paper, box (for nose blows) 1 Sh'N5 3.
Small specimens (hair, nails, Yissue sa:rples, sputum)
Bottles, wide mouth, 1 0 ml 5
SSS2 4.
Excreta, irrication fluids, vcnitus Jar, plastic for feces sampics 2
SF1 -
Urino: specitainers, 2500 5
SF3 Bottics, wide mouth, 500 m1, for co11cetion of irrigation fluids 2
SF4 5.
Skin Smears NUCON smear pads, with envelopes 50 SSK1 PCR OMOINAL 6
3
-_----------,-n..
--Q-
l S/61P5B TAkING KIT (Continuce" Parts list'i structions for use n
0 e
6.
Miscellaneous items Plastic bags, assorted si::cd 10 2 11 Tags, with wire 20 SM2 4
e Labcis, scif-sticking 20 9 13 Patient Radiation and Medical Status Record Sheets (to record specimens collected)'
5 SM4 4
Notebook 1
SMS Pencils-5 SM6 e
e e
s e
e e
e 4
e 4
9 s
e e
e 4
4 e
4 a
6 4
e e
f,.
4 0
O e
4 APPEf! DIX D INVEllTORY OF RADIAT10il El:EP.GEliCY AREA SUPPLIES AllD EQUIPIiEf!T 4
O G
r e
d
+
e S
a w-4 O
.. = -
ALL MEDICAL ITEMS WILL BE BROUGilT FROM Tile EMERGEbCY ROOM AS REQUIRED.
t 6
9 9
9 1
DEC0!!TAMfMATION KIT h0TE: ftcms specified in this kit are to be used for decontamination of hospital areas and equipment.
Quantity Item' Remarks 2 each Sheet Polyethylene (12'x24')
Floor covering 2 each Sheet Polyethylene (3'x12')
Walkway Covering 2 pair Coveralis, Cotton Protective Clothing for Decontamination Personnel 4, pair Gloves, Rubber 2 pair Gloves, Cotton 6 pair Poly Shoecovers 20 each Poly Bags (Large)
Decontamination equipment and Waste Disposal Supplies 1 roll Absorbent Paper (3x12) 2 lit ~
DecontaminationSolution(Concentrated) 2 pains Poly (onegallon) 2 tach
!l cavy Duty scrub Brushes 5 each Carpenters Crayons 1 package Cleaning Rags 1 roll Masking Tape (2")
4 each Signs " Caution Radiation Area" For Posting of area and Identification of Contaminated 4 cach Signs " Caution Radioactive Material" Equipment and Waste 10 each Stickers, " Contaminated Material" l roll Barrier Tape 1 kit Personnel Decontamination Kit Decontaminatitn of H.P. Personnel Portable G.M. Survey Meters and G.M. Counter-scalers will be supplied from the liuclear Power Station as required to support the decontamination operation.
O
..e
e l
(
4 1
2 l
APPENDIX E RADIATION EMERGEI!CY TELEPHONE DIRECTORY t
9 e
I
I,.,
APPEllDIX E RADIAT10:1 Ef4ERGEl:CY TELEPH0llE DIRECTORY llorth Adams Regional Hospital 413-663-3701 Yankee Atomic Electric Company 617-366-9011 John G. Robinson 617-366-9011 Henry B. Cuchanan 617-366-9011 Yankee Rowe t!uclear Power Station 413-625-6393
~
Herbert A. Autio 413-
-o 4819 Plant Superintendent' William G. Jones 413-339-4295 Asst Plant Superintendent Shift Supervisor / Control Room 413-625-6393 Health Physicist / Chem, and H.P. Office 413-625-6393 Coordinatinn Physicians Day
!!ight Robert Davis,14.0.
Limi ted Answering 413-458-5933 413-458-8182 Willian Everett, M.D.
413-458-8182 413-458-5537 John fierselis,11.D.
413-458-8182 413-458-3060 James surgencer,11.D.
413-458-8182 413-458-3283 Ambulance Service Whitingham Ambulance Service 802-368-2323 (Day and liight)
Radiation Management Corporation 215-243-2990 Primary 215-387-5013 Secondary 215-243-2950 Administrative O
(
APPEllDIX F_
LOCATIO,i OE t%fiUALS 3
e B
e C
I e
t j
s e
i 9
4 6
e O
~ - - - ' - - - - - - - - - - - - -
q
?
(_
LOCATIO!! 0F MAtlUALS Radiation Management Corporation Yankee Atomic Electire Company Yankee Rowe fluclear Power Station Plant Superintendent Health Physicis t/ Chem. and H.P. Office Station Treatment Room florth Adams Regional Hospital Administration Office Emergency Room Decontamination Unit flursing Supervisor Office Hospital Engineer Coordinating Physicians R0'ver t D6v is, M.D.
William Everett, M.D.
James Surgencer, M.D.
John Merselis,ii.D.
e O
e
l l
(.
I i
i i
i APPEliDIX G DOSIMETRY LOGS 4
e e
l l
l
I
- RSON!!EL DOSIt'ETRY LOG
(
H
~
N4E ISSUED TLD#
P0CKET PEN READING-DATE RING TLD#
D0SIMETER #
PEN 00SIl4ETER REMARKS i l
C 4
N 99 OWh e
m__
m 4
~ - -
N M.-
m- - _. -
m_
y e
d
...a D6W 4M q
I i
- 3 i
.___.e
^
I e
4
.. m-
ITiRC FORM 195' U.S. NUCLE AR REGULATORY COMMISSION DOCKET NUMBER
(
(;_
50-29 ut m -
e
' NRC DISTRIBUTION > On PAllT 50 DOCKET MATERIAL o l __ s '
A T&
gg-FROM:
^I" Yanhec Atomic Electric Co J
4-8-76 Westborough, Mass J L French DAT,E RECEIVE D 7b OLETTER ONOTORIZED PROP (NPUT FORM NUMDER OF COPIES RECEIVED CORIOINAL
$UNC L ASSIFIE D OcoPY 0 r,0 Cigned DESCRIPTION ENCLOSU RE Ltr re our 10-9-75 itr....trans the - f011 cuing:
North Adaus Regicnal llospftal Procedures......
prepared,by Radia tion Mangenent Corporation..
.........(20 cys enc 1 rec'd)
I
- - ~...
~'
..~
[ } '.' l \\t I
I Yankee Ra'.tc l
SAFETY FOR ACTICN/INFORMATION ENVIRO.. - t.: - 7 e chi i
ASSIGNED AD :
ASSIGNED AD :
y _ PROJECT !!ANAGER: f3or'g p PROJECT MANAGER :
Bl&NCll CliIEF :
Vo y o / 6 BRANCll CHIEF :
g 27TC. AslST. :
5 ko oa rd, LIC, ASST. :
to/a// d h _e INTERNAL OISTRIBUTION
)d' ~ REG.F7LFr- ?
SYSIEMS_ SAFETY PMMI_SYSInm vyyTnn rrm!
M!/
NRC PDR 11ER'EHAH TEDESCn ERNST I'& E (2.)
SCllR0EDER BENAROYA
__13ALIARP QELD 1AIUAS SPAMGLER
.L _.
cOSSICi; & STAFF ENgyiEEjLgg IPPOLITO I
1-IIPC
.___l!ACCABy SITE TECH L._ CASE KNIGitT OPERATING REACTORS CA!O!ILL I
3
__ _ ll6 HAVER SIliWEIL STELLO STEPP 1!ARLESS PAWLICKI llULMAN L_
OPERATING TECll l
PROJECT MANAGEMENT REACTOR SAFETY EISENilUT SITE ANALYSIS
.I _
_ BOYD ROSS SilAO VOLIJER L
P. COLLINS NOVAK BAER BUNCH I
Il0USTON ROSZTOCZY SCllWEliCER J. COLLINS f
i PETERSON CliECK GRIMES KREGER MELTZ
,l
_ _ _ IlELTEMES AT & I SITE SAFETY & EtiV E~C
'I Q
SKOVil0LT Ide SALTZMAN ANALYSIS RUTBERC Dr.IITON & MUT.LER EXTERNAL DISTRIBUTION CONTROL NUMBER
/
1,PIDR: G m.un4li.M (N 1 NATL LAlf BROOldlAVEN NATL LAB
,/ )
L/ /
L
-NSIC
- LA PDR
/
ASLB CONSULTANTS 110LDlM01E!B'1
' _._ ACKS r
.se ron.o uuu.uu
- - - - -i