ML20216J875

Licensee Submittal Re Emergency Medical Svcs (10CFR50.47(b)(12)).* Completed Arrangements for Offsite Emergency Medical Svcs,Including Annual Conduct of Emergency Drills Since 1981,discussed

ML20216J875
Person / Time
Site:	San Onofre
Issue date:	06/29/1987
From:	Pigott D ANAHEIM, CA, RIVERSIDE, CA, SAN DIEGO GAS & ELECTRIC CO., SOUTHERN CALIFORNIA EDISON CO.
To:
References
CON-#387-3932 OL, NUDOCS 8707070061
Download: ML20216J875 (185)

Text

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'87 WN 30 P3 :33 3

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4 4 UNITED STATES OF AMERICA DOCht N. -

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5 NUCLEAR REGULATORY COMMISSION 6

7 In the Matter of )

8 )

SOUTHERN CALIFORNIA EDISON -) DOCKET NOS. 50-361 OL 9 COMPANY, et al. ) 50-362 OL

)

10 (San Onofre Nuclear Generating )

Station, Units 2 and 3) )

11 )

12 i 13 LICENSEES' SUBMITTAL RE EMERGENCY )

MEDICAL SERVICES (10 C.F.R. 50.4?(b)(12).)

-14

' '15 DAVID R. PIGOTT CATHERINE K. O'CONNELL 16 ORRICK, HERRINGTON & SUTCLIFFE 600 Montgomery Street 17 San Francisco, California 94111 Telephone: (415) 392-1122 18 CHARLES R. KOCHER 19 JAMES A. BEOLETTO SOUTHERN CALIFORNIA EDISON' 20 COMPANY '

P.O. Box 800 21 2244 Walnut Grove Avenue Rosemead, California 91770 22 Telephone: (818) 302-1212 23 Attorneys for Licensees Southern California Edison 24 Company, San Diego Gas & Electric Company 25 City of Anaheim, California and City of Riverside, California 26 Dated: June 29, 1987 1450o g h 00p g3

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< 9 1 LICENSEES' SUBMITTAL RE EMERGENCY MEDICAL SERVICES (10 C.F.R. 50.47(b)(12))

2 3 I. INTRODUCTION 4 By Order dated January 13, 1987 the Atomic Safety &

5 Licensing Board (" Board"), in the above captioned action, 6 required Licensees (Southern California Edison Company, San 7 Diego Gas & Electric Company, City of Anaheim and City of 8 Riverside, California) to submit by July 1, 1987, 9 documentation of having implemented emergency medical 10 arrangements in conformity with 10 C.F.R. 50.47(b)(12). The 11 requirement of 10 C.F.R. 50.47(b)(12) was initially defined in 12 " Criteria for Preparation and Evaluation of Radiological 13 Emergency Response Plans and Preparedness in Support of 14 Nuclear Power Plants," NUREG-0654 FEMA-REP-1 Rev. 1 ("NUREG

'15 0654") issued in 1980. More recently, it was further defined 16 in " Guidance Memorandum MS-1, Medical Services" issued by FEMA 17 in coordination with the NRC Staff ("MS-1"). Licensees have  ;

I 18 now completed their arrangements for offsite emergency medical 1 l

19 services. Licensees believe such arrangements fully satisfy 20 the requirements of 10 C.F.R. 50.47(b)(12) as interpreted in i

21 NUREG 0654 and MS-1. By this filing Licensees submit a l 1

22 description of said arrangements along with supporting l 23 documentation.

24 II. PROCEDURAL BACKGROUND 25 On May 14, 1982 the Board authorized full-power i

26 I operating licenses for San Onofre Nuclear Generating Station i

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• f 1 (" SONGS"), Units 2 and 3. The authorization was conditioned, 2 however, on Licensees developing within six months, in 3 conformity with the Board's interpretation of 10 C.F.R. 4 50.47(b)(12),1/ offsite medical arrangements for pe: sons who 5 may become contaminated and/or injured in the event of an 6 accident. Groups United Against Radiation Danger (" GUARD"),

7 an Intervenor, then sought to stay the Board's decision 8 granting the operating licenses. That request was denied. On 9 appeal of that decision the Atomic Safety and Licensing Appeal 10 Board again cenied the requested stay but stated in dictum ,

l 11 that it interpreted 50.47(b)(12) to refer only to persons who i 12 are both contaminated and physically injured.

13 The NRC declined to review the Appeal Board's denial 14 of the stay but, because of the differing opinions of the two 15 Boards, directed certification of two questions:

l

- 16 (1) Does the phrase " contaminated injured

( individuals" as used in 10 C.F.R. 17 50.47(b)(12) require applicants for nuclear power plants to provide arrangements for 1 18 medical services only for members of the public who have suffered traumatic [ physical}

19 injury and are also contaminated with radiation?

20 (2) If the answer to Question 1 is no, to what 1 21 extent does 10 C.F.R. 50.47(b)(12) require )

advance, specific arrangements and 22 commitments for medical services for the general public as opposed to the general 23 knowledge that facilities and resources exist and could be used on an ad hoc basis?

24 25 l

1/ 10 C.F.R. 50.47(b)(12) provides in part that emergency 26 response plans must include "la]rrangements . . . for medical services for contaminated injured individuals."

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• 1 1 In answering the certified questions the NRC held 2 that Section 50.47(b)(12) requires that arrangements for 3 medical services be made for those individuals who suffer only 4 radiation exposure. The Commission also held that the 5 requirement for medical services would be satisfied by 6 providing a list identifying . scal and regional medical 7 facilities which have the capabilities to provide necessary 8 treatment and that pre-accident arrangements with the 9 particular facilities were not necessary. The Commission then 10 remanded the proceedings to the Licensing Board.

11 Following remand, the Licensees moved for and were 12 granted permission to augment the record before the Licensing 13 Board. The Licensees then provided the Board with documents 14 outlining the actions taken to comply with the Commission's

'15 order. These actions included: (a) forwarding to the 16 responsible emergency personnel for the Counties of Orange and 17 San Diego and the cities of San Clemente and San Juan 18 Capistrano a listing of three hospitals which had agreed in 19 writing to provide medical services to individuals who may be 20 traumatically injured and contaminated as a result of an 21 accident at SONGS; and (b) providing the County of Orange and 22 County of San Diego with a list of additional hospitals that 23 may, on a regional basis, be appropriate for medical services 24 planning, as needed.

25 Based on that submission, the Board concluded that 26 Licensees had met their burden of proof and had demonstrated 3

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. i 1 reasonable assurance regarding the arrangements for medical-2- services required by 50.47(b)(12). When the Board refused 3 Intervenor GUARD's request to inquire of Licensees concerning 4 the specific capabilities of the listed facilities GUARD 5 sought review of the NRC's interpretation of 10 C.F.R. 6 50.47(b)(12), as applied to SONGS, in the U.S. Court of 7 Appeals for the District of Columbia Circuit.

8 In Guard v. NRC, 753 F.2d 1144 (D.C. Cir. 1985) the 9 D.C. Circuit vacated and remanded for further consideration 10 that part of the NRC's SONGS decision which had held that 11 under 50.47(b)(12) the only planning. required was the 12 preparation of a list of local treatment facilities. On 13 remand, the Commission directed the NRC staff, with FEMA, to 14 develop and issue appropriate guidance on the arrangements

'15 necessary for medical services for offsite exposed individuals.

16' III. REQUIREMENTS FOR MEDICAL ARRANGEMENTS 17 On November 13, 1986 FEMA issued the 18 above-referenced MS-1, " Guidance Memorandum (GM) MS-1, Medical 19 Services". A copy of MS-1 is attached hereto as Exhibit 1 and 20 is incorporated by reference.

21 MS-1 further interprets and clarifies the 22 requirements contained in 50.47(b)(12) and the earlier 23 guidance in NUREG 0654. It provides standards, evaluation 24 criteria, areas of review and acceptance criteria for four l 25 specific areas: agreements with hospitals; transportation i

26 arrangements; radiological emergency response training; and j l

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.. . . . ._ - _. _._ _. . - - . . - - b

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. f 1 exercises and drills. Each area is discussed further below.

2 A. Agreements with Hospitals.

3 MS-1 requires either state or local government or 4 the licensee to have written agreements with a local and a 5 backup hospital which have the capability to treat 6 contaminated injured individuals. The agreements should l 7 contain " simple assurances" of such capability, for example, 8 through accreditation by the Joint Commission on Accreditation 9 of Hospitals (JCAH). Each local and backup hospital shall 10 have on call within about two hours at least one physician and 11 one nurse who can supervise the treatment of radiologically 12 ' contaminated injured" members of the general public.

l 13 B. Transportation.

14 Arrangements are required for transporting victims 15 of radiological accidents to medical support facilities.

16 Agreements with the transportation providers should be in 17 writing.

18 C. Training.

19 Radiological emergency response training is to be 20 provided to those who may be called upon in an emergency.

21 Training extends to doctors, nurses, other emergency room 22 personnel, paramedics and emergency medical technicians.

23 D. Exercises and Drills. 1 I

24 MS-1 requires periodic exercises and drills designed

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1 25 to evaluate major portions of response capabilities and to 26 develop the skills necessary to respond in the event of an 1

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1 accident. Such drills and~ exercises, in addition to providing 1

2 . training'and assurance of competence, may identify j 3 deficiencies which will then be the subject of corrective 4 action.

5 IV. MEDICAL ARRANGEMENTS AT SAN ONOFRE 6 As previously discussed, 10 C.F.R. 50.47(b)(12) 7 requires that " Arrangements are made for contaminated injured 8 individuals." Planning Standard "L" of NUREG-0654 provided 9 initial guidance for compliance with the regulation. As 10 outlined above, FEMA Guidance Memorandum MS-1 provides further L

l.

11 interpretation and clarification of 10 C.F.R. 50.47(b)(12) i 12 pursuant to the D.C. Circuit's decision in GUARD v. NRC, 753 1

13 F.2d 1144 (D.C. Cir. 1985). In compliance with all of the

' 14 - above, Licensees have implemented the following arrangements

'15 which they believe fully satisfy both the letter and spirit of 16 the NRC regulations.

.17 A. Agreements With Hospitals.

I 18 Licensee Southern California Edison Company ("SCE"), )

19 as operator of SONGS, has obtained written agreements from 20 four hospitals located in the vicinity of the plant (the 21 " agreement hospitals"). Copies of those agreements are 22 attached hereto and incorporated herein as Exhibits 2 thru 5:

23 Exhibit 2. Letter agreement of January 22,.1987 24 between South Coast Medical Center, 31872 25 Coast Highway, South Laguna, California 26 92677 and SCE.

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1 Exhibit 3. Letter agreement of January 22, 1987 2 between Mission Community Hospital, 27700 3 Medical Center Road, Mission Viejo, 4 California 92691 and SCE.

5 Exhibit 4. Letter agreement of January 22, 1987 6 between San Clemente General Hospital, 654 7 Camino De Los Mares, San Clemente, 8 California 92672 and SCE.

9 Exhibit 5. Letter agreement of January 22, 1987 10 between Tri-City Hospital, 4002 Vista Way, 11 Oceanside, California 92056 and SCE.

12 Each hospital is accredited by the Joint Commission on 13 Accreditation of Hospitals.

14 The agreements each provide for temporary house 15 privileges for designated SCE physicians to assist in the care 16 and treatment of contaminated injured individuals if 17 necessary. The agreements specifically contemplate treatment 18 of members of the general public as well as SCE personnel or 19 other individuals who may have been injured at the station.

20 Each of the agreement hospitals maintains its 21 emergency room on a continuous basis. Each hospital has on 22 its staff doctors capable of treating patients who have 23 suffered excess radiation exposure or are contaminated with 24 radiation and are traumatically injured. Additionally, each 25 hospital has on its staff, nurses who are trained and capable 26 of treating the above described patients. Both doctors and 7

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1- nurses could. respond in a very short time in the event of an 2 accident.

3 SCE has in its employ, in the vicinity of SONGS, 4 three medical doctors capable of treating injured, 5 contaminated individuals.

6 Licensees also have arrangements with three 7 independent physicians who are equally qualified. Copies of 8 their agreements are attached. hereto as:

9 Exhibit 6. Letter agreement of February 4, 1987 from 10 F.C. Jackley of SCE to John P. Chard, M.D.

11 Exhibit 7. Letter agreement of February 4, 1987 from 12 F.C. Jackley of SCE to Joseph F. Ross, M.D.

13 Exhibit 8. . Letter agreement of February 4, 1987 from 14 F.C. Jackley of SCE to Bernard L. Bundy,

'15 M.D.

16 Physicians from each of the above three groups would 17 be available on short notice in the event of an emergency 18 situation at SONGS.

19 In addition to Licensee's agreements, the County of 20 Orange and the County of San Diego have, as a part of their 21 response plans, understandings with other hospitals located 22 within the respective counties. Said hospitals are accredited P3 by the JCAH. The listing of available regional hospitals is 24 found in the respective county plans as set forth in

.25 Exhibits-9 and 10, 26 ///

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1 Exhibit 9. ~ County of Orange, Incident Response Plan j 2 for San Onofre Nuclear Generating Station, 3 Interjurisdictional Procedures No. 12, 4 Attachments 7.6 and 7.7..

5 Exhibit 10. . San Diego County Nuclear Plant Emergency 6 Response Plan, Standard Operating 7 Procedure No. 12, Attachment 6.

l 8 The hospitals listed in Exhibits 9 and 10 have an 9 approximate total number of beds of: San Diego 1,431, and 10' Orange 5,553.

11 B. Transportation Arrangements.

.l 12 Licensee SCE has entered into agreements with two 13 private companies as well as the City of San Clemente Fire 14 Protection Department for ambulance services. Said agreements

15. are attached hereto and incorporated herein as Exhibit 11, 12 i 16 and 13, 17 Exhibit 11. Letter agreement of January 22, 1987 l

18 between Scudders Ambulance Company, 25260 {

J 19 East La Paz Road, Suite 4, Laguna Hills, 20 California 92654 and SCE. '

21 Exhibit 12. Letter agreement of March 23, 1987 between 22 Med Air, Flight Operations, P.O.

23 Box C-11912, Santa Ana, California 92711 24 and SCE.

25 Exhibit 13. Agreement of May 6, 1987 between the City

26. of San Clemente and SCE.

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i 1 In each instance the agreement provides for 2 transportation of injured contaminated individuals, who may be

3. members of the general public as well as SCE employees and 4 other station personnel, to the appropriate hospital.

5 In the event it is necessary to resort to the use of 6 the regional hospitals listed in the Orange and/or San Diego 7 County plans, transportation would be provided either by the 8 contract ambulance service or through mass transportation 9 pursuant to county direction. As reflected in both San Diego 10 and Orange County plans, in the event necessary, the municipal 11 bus facilities would be available to transport contaminated or i

12 exposed patients. These preparations are' reflected'in 13 Exhibits 14 and 15 which are portions of the Orange and San 14 Diego County plans and which, by this reference are

'15 incorporated herein.

16 Exhibit 14. County of Orange Incident Response Plan 17 for San Onofre Nuclear Generating Station, 18 Interjurisdiction Procedure No. 9 19 (Transportation).

20 Exhibit 15. San Diego County Nuclear Plant Emergency 21 Response Plan, Standard Operating 22 Procedure No. 9 (Transportation) 23 C. Training.

24 SCE has had in place for several years, programs to

'25 train hospital workers and ambulance drivers in the 26 appropriate: treatment and handling of contaminated injured 10 1450o L 2

1 individuals. Examples of these training programs are attached 2 hereto as Exhibits 16 and 17 and are incorporated by reference 3 herein.

4 Exhibit 16. The Handling and Treatment of 5 Radioactively Contaminated and Injured 6 Patient (s) by Emergency Department

-7 Physicians and Nurses, Prepared for 8 Tri-City Hospital, Oceanside, CA.

9 Exhibit 17. The Handling and Treatment of 10 Radioactively Contaminated and Injured 11 Patient (s), By Emergency Department 12- Physicians and Nurses, Prepared for 13 Scudders Ambulance Service and San 14 Clemente Paramedic Units.

15. These exhibits reflect materials utilized as part of 16 Licensees' most recent training programs.

17 D. Exercises and Drills.

18 Medical Emergency Drills have been conducted at

.19 least annually since 1981. The drills have involved the 20 participation of some, if not all, of the local medical 21 support personnel and organizations (e.g., physicians, 22 ambulance services and hospitals) and have involved simulated 23 contaminated / injured individuals. Drills have been a part of 24 'the annual exercise and have also been conducted separately.

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1 V. CONCLUSION 2 Licensees submit that the foregoing arrangements 3 fully satisfy the requirements of 10 C.F.R. 50.47(b)(12).

4 Dated: June 29, 1987 Respectfully submitted, 5 DAVID R.PIGOTT CATHERINE K. O'CONNELL 6 ORRICK HERRINGTON & SUTCLIFFE 7 CHARLES R. KOCHER JAMES A. BEOLETTO 8 SOUTHERN CALIFORNIA EDISON COMPANY I 9

10 DAVID R. PIGOTT 11 Attorneys for Licensees Southern California Edison 12 Company, San Diego Gas &

Electric Company City of 13 Anaheim, California and City of Riverside, California 14

'15 16 17 18 19 20 21 22 23 24 25 26 l

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l 1 DECLARATION OF SERVICE OF MAIL 2 3',I T '

v 2

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'87 JUN 30 P3 :34 I am over the age of eighteen years and not a party 1

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4 to the above-entitled cause. Mybusinessaddressis60d}f f w:

5 Montgomery Street, 14th Floor, San Francisco, California 94Ill.~

6 I served the foregoing LICENSEES' SUBMITTAL RE 7 EMERGENCY MEDICAL SERVICES (10 C.F.R. 50.47(b)(12)) dated 8 June 29, 1987, by depositing a true copy thereof in the United 9 States mail in San Francisco, California, on June 29, 1987, 10 enclosed in a sealed envelcye with postage thereon fully 11 prepaid, addressed as follows:

12

• Stephen F. Eilperin, Esq.

Chairman, Atomic Safety and 13 Licensing Appeal Board U.S. Nuclear Regulatory Commission 14 Washington, D.C. 20555 15

• Dr. Reginald L. Gotchy Dr. Cadet H. Hand, Jr.

Atomic Safety and Licensing Administrative Judge 16 Appeal Board c/o Bodega Marine Laboratory U.S. Nuclear Regulatory Commission University of California 17 Washington, D.C. 20555 P.O. Box 247 18

• Dr. W. Reed Johnson Atomic Safety and Licensing Mrs. Elizabeth B. Johnson 19 Appeal Board Administrative Judge U.S. Nuclear Regulatory Commission Oak Ridge National Laboratory 20 Washington, D.C. 20555 Oak Ridge, TN 37830 21

• Sheldon J. Wolfe, Chairman Robert Dietch, Vice President Administrative Judge Southern California 22 Atomic Safety and Licensing Edison Co.

Board 2244 Walnut Grove Avenue 23 U.S. Nuclear Regulatory Commiscion Rosemead, CA 91770 Washington, D.C. 20555 25 26 6

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• Lawrence J. Chandler, Esq. Charles R. Kocher, Esq.

Donald F. Hessell, Esq. James A. Beoletto, Esq.

2 Nuclear Regulatory Commission Southern California j Office of the Executive Legal Edison Co. I 3 Director 2244 Walnut Grove Avenue Washington, D.C. 20555 Rosemead, CA 91770 4

Mrs. Lyn Harris Hicks Mr. Lloyd von Haden 5 GUARD 2089 Foothill Drive 3908 Calle Ariana Viste, CA 92083 ,

6 San Clemente, CA 92801 ]

James F. Davis 1 7

• Richard J. Wharton, Esq. State Geologist  !

University of San Diego Division of Mines and Geology j 8 School of Law 1416 Ninth Street, Room 1341 l Alcala Park Sacramento, CA 95814 {

9 San Diego, CA 92110 Phyllis M. Gallagher, Esq.

10

• Janice E. Kerr, Esq. 1695 W. Crescent Avenue J. Calvin Simpson, Esq. Suite 222 11 Lawrence Q. Garcia, Esq. Anaheim, CA 92801 California Public Utilities 12 Commission Atomic Safety and Licensing l 5066 State Building Appeal Board 13 San Francisco, CA 94102 U.S. Nuclear Regulatory l

Commission l 14

• Charles E. McClung, Jr., Esq. Washington, D.C. 20555 24012 Calle de la Plata 15 Suite 330 Atomic Safety and Licensing Laguna Hills, CA 92653 Board 16 U.S. Nuclear Regulatory Alan R. Watts, Esq. Commission 17 Rourke & Woodruff Washington, D.C. 20555 701 S Parker St., #7000 18 Orange, CA 92668-4702

• Samuel J. Chilk Secretary of the Commission 19

• James C. Holcombe U.S. Nuclear Regulatory Louis Bernath Commission j 20 San Diego Gas & Electric Co. Washington, D.C. 20555 j 101 Ash Street  !

21 San Diego, CA 92101 22 l 23 1 i

l 24 {

• VIA Federal Express j 25  ;

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2 5701p L- _ _ _ _ _ _ _ - - - - - - - - - - - - - - - - - - - ___

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1 Executed on June 29, 1987, in the City and County of 2 San Francisco, State of California.

3 I declare under penalty of perjury that the 4 foregoing is true and correct.

5 6

Christine P. Swor 7

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S(atsE.& Qlf SSINS No.: 6835 IN 86-98 UNITED STATES NUCLEAR REGULATORY COMMISSION n t:. C E I V r '

0FFICE OF INSPECTION AND ENFORCEMENT WASHINGTON, D.C.

DEC 8 1986 2C555 December 2, 1986 Em IE INFORMATION NOTICE NO. 86-98: 0FFSITE MEDICAL SERVICES Addressees:

l All nuclear power reactor facilities holding an operating license or a con- i struction permit. '

~

Purpose:

This information notice is provided to bring to the attention of licensees a new Commission policy on offsite medical services around nuclear power plants and a Federal Emergency Management Agency (FEMA) guidance memorandum addressing that policy. It is suggested that recipients review the information for appli-cability to their facilities. No written response is required. l Description of Circumstances:

Attached is FEMA Guidance Memorandum MS-1, " Medical Services," that addresses implementatien of the Commission policy on offsite medical services published on September 17, 1986 in the Federal Register (51 FR 32904). This Guidance Memorandum was prepared in coordination with the NRC staff. As noted .in the referenced policy statement, the Commission has determined that these modifi-cations fall under the backfit rule's exception as necessary to bring facili-ties into compliance with a rule of the Commission.

No written response is required by this information notice. If you have any questions about this matter, please contact the Regional Administrator of the appropriate regional office or this office.

dward L. ordan, Director Division Emergency Preparedness and Engineering Response Office of Inspection and Enforcement Attachments:

1. FEMA Guidance Memer'andum MS-1

2. List of Recently Issued IE Information Notices Technical

Contact:

Edward M. Podolak, IE (301) 492-7290 8611260006 EX. 1

4 O

Attachment 1 IN 86-18 December 2, 1986 Page 1 of 12 l Federal Emergency Management Agency Wahington, D.C. 20472 Regional Directors MD10RANDW IVR:

Actirq Regional Directors M \g%

FRCH: cloughlin puty Associate Director State and Iocal Programs and Stpprt STATECT: Guidance Memorandtzn (G4) MS-1, Medical Services ne attached m MS-1, Medical Services, is fotvarded for your use in providirg guidance to State and local officials in developirg their radiological e.ergency response plans ard in evaluating the mr'iical

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services capabilities of State ard local goverments.

Re origins of this GM ard its development and approval have been scre.. hat '

different fran other 04's. Eis 04 was developed as a result of a series of legal decisions involviry tac which determined that the existirg interpretation of the required pre-accident medical arrangements for contaninated injured individuals was not sufficient. Those decisions led NRC to issue a policy statement (Attachment B) on September 17, 1986, indicatirg that the NRC staf f (in consultation with FD4A) would develop detailed guidance on the necessary pre-accident arrargements for medical services by November 17, 1986.

We have worked closely with NRC in recent weeks in the preparation of this guidance. Unfortunately, the short deadline did not permit our usual procedure of obtainirq Regional ard other otranents before issuiry this final guidance.

If you have any questions about MS-1, you may contact James 'Ihomas at 646-2808. A list of all current operative G4's ( Attactrnent C) is also prcnided for your information.

A"ATAONctrS :

A. Oi MS-1, Medical Services B. Dnergency Plannirn - Medical Services, September 17,19 86, 51 FR 33 04 C. List of Operative Qi's

s s

Attachment 1 IN 86-98 December 2, 1985 Page 2 of 12 y,,.

yi Federal Emergency Management Agency g Washington, D.C. 20472 j

GUl0ANCE MEMORANDUM MS-1 MEDICAL SERVICES Purpose This Guidance Memorandum (GM) provides interpretation and clarification of requirements contained in the Nuclear Regulatory Cormission rule.10 CFR 50.47 (b)(10) and the associated guidance in NUREG-0654/ FEMA-REP-1 Revision 1, re-lated to the provision of medical services for members of the general public.

Background

The background is contained in a policy s ta tement frc,m the Nuclear Regula tory Co mission (NRC) titled " Emergency Planning - Medical Services" (51 FR 32904),

in this policy statement, NRC states its belief that 10 CFR 50.47(b)TI2)

(" arrangements are made for medical services for contaminated injured individuals") requires pre-accident arrangements for medical services (beyond the maintenance of a list of treatment facilities) for individuals who might be severely exposed to dangerous levels of of fsite radiation following an accident at a nuclear power plant. As used in 10 CFR 50.47(b)(12) and planning Standard "L" cf NUREG-0654/ FEMA-REP-1, Revisicn 1, the terri " contaminated injured" means

1) contaminated and otherwise physically injured; 2) contaminated and exposed to dangerous levels of radiation; or 3) exposed to dangerous levels of radiation.

Guidance 10 CFD 50.47 (b)(12) requires that " Arrangements are made for contaninated injured individuals." In its policy statement the NRC detern:ined that this standard requires pre-accident arrangements for medical services for offsite  !

individuals who might be exposed to dangerous levels of radiation following an accident at a nuclear power plant. The following guidance applies to the eval-uation of the medical services aspects of State and local emergency plans under the criteria in NUREG-0554/ FEMA-REP-1.

Standards, Evaluations Criteria, Areas of Reviews and Acceptance Criteria A. Assignment of Responsibility (OrganizationControll Planning Standard Primary responsibilities for emergency response by the nuclear facility licensee, and by State and local orgenizations within the Energency Flanning Zones have been assigned, the energency responsibilities of the various sup-porting organizations have been specifically established, and each principal response org:nization has staff to respond and to augment its initial response on a continuous basis.

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Attachment i IN 86-98~

December 2. 1986 Page 3 of 12 i

A.3. Evaluation Criterion Each plan shall include written agreements referring to the concept of operations developed between Federal, State, and local agencies and other support organizations having an emergency response role within the Emergency Planning Zones. The agreements shall identify the emergency measures to be provided and the mutually acceptable criteria for their implementation, and specify the arrangements for exchange of information. These agreements may be provided in an appendix to the plan or the plan itself may 'contain descriptions of these matters and a signature page in the plan may serve to-verify the a greement s. The signature page format is appropriate for organizations where response functions are covered by laws, regulations or executive orders where j separate written agreements are not necessary.

l Areas for Review and Acceptance Criteria State or local governments should obtain written agreements with the listed redical facilities (Planning Standard L. Evaluation Criteria 1 and 3) and trans-portation providers (Planning Standard L. Evaluation Criterion 4). The written agreements should contain simple assurances that the providers have adequate j

technical information (e.g. treatment protocols) and treatment capabilities for handling " contaminated injured" individuals. An indication of Joint Comission on Accreditation of Hospitals (JCAH) accreditation will suffice for such' assurance. 1 (Note: Veterans Administration (VA), military and other government hospitals I are not usually accredited by JCAH but usually have the desired capabilities.) I If state or local governments do not obtain written agreements, the licensee should obtain written agreements with the listed medical facilities and trans-portation providers. If good faith efforts are not successful in a particular case, the licensee shall provide or arrange for adequate compensatory measures, e.g., obtain written agreements with other providers or provide temporary field medical care. .

L. Medical and Public Health Support Planning Standard 1

Arrangements are made for medical services for contaminated injured individuals.

L.I. Evaluation Criterion Each organization shall arrange for local and backup hospital and medical services having the capability for evaluation of radiation exposure and uptake, including assurance that persons providing these services are adet;uately prepared to handle contaminated individuals.

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Attachment i IN 86-93 Decemoer 2, 1986 Page 4 of 12

_3 Areas' for' Review and Acceptance Criteria There should be one primary local hospital and one backup hospital for each site for the evaluation and' emergency trea tment of " contamination injured" members of the general public. Hospitals are generally distributed proportional to the population. Thus, at sites with icw population and few hospitals, the primary local and backup hospitals for members of the general public could be the same as those for the utility employees and emergency workers.

L.3. Evaluation Criterion Each state shall develop lists indicating the location of public, private and military hospitals and other emergency medical services facilities within the State or contiguous States considered capable of providing ' medical support for any contaminated injured individual. The listing shall include the name, location, type of facility and capacity and any special radiological capabili-ties. These emergency medical services should be able to radiologically monitor contaminated personnel, and have facilities and trained personnel able to care for contaminated injured persons.

Areas for Review and Acceptance Criteria The lists should be annotated to indicate the ambulatory /non. ambulatory capaci-ties for providing medical support for " contaminated injured" members of the general public and any special radiological capabilities. This will enable state and local officials to direct members of the general public to those institutions capable of handling " contaminated injured" patients. In the event that local and regiora1 medical resources need to be supplemented, additional medical re-sources would be available through the Federal Radiological Emergency Response Plan. These resources would include the Radiation Emergency Assistance Center /

Training Site at Oak Ridge, Tennessee and the National Disaster Medical System l with headquarters in Reckville, Maryland.

L.4. Evaluation Criterion Each organization shall arrange for transporting victims of radiological acci-dents to redical support facilities.

Areas for Review and Acceptance Criteria l Because the early symptoms of persons exposed to dangerous levels of radiation are usually limited to nausea and vomiting, ambulances may not be required to transport such persons to medical facilities. Rather, non-specialized public and private vehicles can be used, supported, if necessary, with agreements in accordance with A.3. above. For other types of contaminated injured individ-uals, specialized transportation resources (e.g. , ambulances) would be necessary and should be assured by agreements, if necessary, in accordance with A.3 above.

Provisions should be made for the use of contamination control in transporting contaminated persons to medical facilities.

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e Attachment i IN 86-98 December 2, 1986 Page 5 of 12 planning Standard O. Radiological Emergency Response Training l

Radiolog8c.a1 emergency response training is provided to those who may be called un to assist in an emergency.

0.4. Evaluation Criterion Each organization shall establish a training program for instructing and quali-  ;

fying personnel who will implement radiological emergency response plans. The specialized initial training and periodic retraining programs (including the scope,_ nature and frequency) shall be provided in the following categories:

h. Medical support personnel Areas for Review and Acceptance Criteria Each hospital listed under Evaluation Criteria L.1 and L.3. shall have at least one physician and one nurse on call within about 2 hours2.314815e-5 days <br />5.555556e-4 hours <br />3.306878e-6 weeks <br />7.61e-7 months <br /> who can supervise the evaluation and treatment of radiologically " contaminated injured" members of the general public. There are several sources for this training including NRC licensee sponsored training. Transportation providers should have basic training in ccntamination control. Examples include but are not limited to:

1. FEMA handbook, videotape, slides and instruction manual titled " Hospital Emergency Department Management of Radiation Accidents." SM 80/1984 l 2. Courses from The Radiation Emergency Assistance Center / Training Site l (REAC/TS) at Oak Ridge Associated Universities.

3. Audiocassette and text course, " Radiation Accident Preparedness: Medical and Managerial Aspects" by Science-Thru-Media Inc., 303 Fifth Avenue, Suite 803, New York, NY 10016.

N. Exercises and Drills  !

i planning Standard Periodic exercises are (will be) conducted to evaluate major portions of emer-gency response capabilities, periodic drills are (will be) conducted to develop and maintain key skills,, and' deficiencies identified as a result of exercises or drills are (will be) corrected.

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i Attachment 1 i In 86-98  !

December 2. 1986 Page 6 of 12 N.2. Evaluation Criterion A drill is a supervised instruction period aimed at testing, developing and maintaining skills in a particular operation. A drill is often a component of an exercise. A drill shall be supervised and evaluated by a qualified drill instructor. Each organization shall conduct drills in addition to the biennial ammwal* exercise at the frequencies indicated below:

c. Medical emergency drills A medical emergency drill involving a simulated contaminated individual which contains provisions for participation by the local support services agencies (i.e., ambulance and offsite medical treatment facility) shall be conducted annually. The offsite portions of the medical drill may be performed as part cf the required biennial amnwal* exercise.

Areas for Review and Acceptance Criteria State or local governments should provide for the conduct of appropriate drills and exercises which include " contaminated injured" individuals. These medical emergency drills involving the primary local (L.1.) hospital for state and local governments should be conducted annually. These drills should also test the capability of relocation centers to direct " contaminated injured" members of the general public to the apprcpriate hospital. If State or local governments cannot provide for the cc S ct of the drills, the licensee shall provide for the con-duct of such drili If good faith efforts are not successful fr. a particular case, the licensee shall provide or arrange for adequate compensatory measures.

Implementation State and local emergency response plans should reflect the provisions of this GM at the next annual update following 9 months from the effective date of this GM.

Plans for plants that do not have a full power operating license should reflect the provisions of this GM within 9 months of the effective date of this GM. The first medical drill reflecting the provisions of this GM should be conducted by the end of the next biennial exercise following 1 year from the effective date of this GM. -

• Changes reflect language incarporated into GM PR-1.

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j Attachment I l IN 86-98  ; .

December 2, 1986 Page 7 of 12 ) i l

NRC Coordination This Guidance Memorandum has been prepared in coordination with the NRC staff.

As noted in the referenced NRC Policy Statement, the Commission has determined that these modifications fall under the backfit rule's exception as necessary to bring facilities into compliance with a rule of the Comission.

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Att anm e i a ob-s ~ l De m 1er* 2, 1986 i Idp 5 O f I d At tach:nent B 3:24 Federal Register / Vol. 51. No.180 / Wednesday. September 17. 1986 / Roles and Resrulations '

such ad6tional anangements, the decision"), the Commlnion itself faced l Commission leaves to the Informed for the hrst eme the question whether ludenent of the NRC staff, subject to planning standard (b)(12) apphed to general guidance from the Commission. snembers of the public who were l the erset parameters of the minimally exposed to offsite rs&ation following am necessary arrangements for medical accident at a nudear power facility but serdces. To fulfill this mandate the staff were not otherwise injured, and if so to (and FEMA) willissue appropriate what extent, in considering this )

guidance to licensees, applicanta, and question, the Commission sought the j

state and local governinents. .

views of the parties in the SONCS i

The United States Court of Appeals proceeding. nyiewed the principal for the District of Columbia (" Court") purposes of the planning standard, vacated and remanded a previous analyud the hkehhood of serious Commisalon interpretation of plannint exposures to the public requtring standard (b)(12) which required only the emergency medical treatment, and '

development and maintenance of a list evaluated the type of emergency of tnetment facilities on which post

• treatment likely to be required. Ba sed on event, adhoc anangements for medical thja nview. the Coruninion concluded treatment could be based. CUARD v. as a generic matter that:(1) Planning

. NRC 753 F.2d 1M4 (D C. Cir.1985). standard (b)(12) applied to individuale Pending final Commission action in both ofuits and offsite,(2) response to the CUARD remand, the

" contaminated injund in6viduals" wee Comminion issued a statement of intended to indude seriously ina6ated interim guidance which permitted, members of the public as well as pursuant to 10 CFR 50 47(c)(1), the inuance of full power licenses whe e soembers of the public who are not seriously irradiated but also are the applicant satisfied the requirements of planning standard (b)(12) as trenmaticalty injured from other causes Interpreted by the Com= lesion prior to and rndiologically contaminated. and (3)

CUARD. and where the applicant Adequate, post. accident arrangements committed to full compliance with the for sectuary me6 cal trestrnent of Cominission's final response to the exposed members of the public could be made on an adhoe basis tf emergency CUARD remand. The Cornmission's plana contained a bat c!!ocal tnetmant prior interim guidance will contmue to {,cigj tj,,,

govern the lasuance of full power heenses untd issuance and On appeal, the United States Court of trnplementation of the NRC stafTe Appeals for the D C. Circuit conduded specific guidance on this matter, et that the Commission had not reasonably which potnt the new policy will apply, interpreted planning standard (b.)(12) arrtetrys oatz: September 17.1966. when it genencally found that a pre-accident tis of treateent facilities Pom FURTNem 18tronWaT1ost CostTACT7 constituted "arrargements" for pos t.

C. Sebastian Aloot. OfTice of the accident medical treat =ent CUARD v.

General Coun sel. U.S. Nuclear NUCt.E AR RECULATORY Re1r.datory Commission, Wa shington, NRC 753 F.2d tu4 (D.C. Cir leas). For COMMIS310N DC 20555. Telephone (202) 63442.24. this na son. the Cou:t vacated and remanded that part of the Commission's sum.swewTany seromuatx>c SONGS decision that be d interpreted 10 CFR Part 50 L introduction planning standard (b)(12) to require only Em:rgency Planning-adedical the preparation of a bet oflocal l Gervices In the wake of the Three Mie taland treatment facibties. However. in doms accadent in 1979, the Nudear Regulatory so, the Court made dear '. bat the A1eter: Nuclear Regulatory Commission ("NRC" or Commission") Commission had on reman 1 Ln its round Comminion. discreuen. flexibihty in fashionjng a

{romulgnted censees andregulations applicacts f rrequiring its

) ACTitec Staternent of Policy on licanaes to reasonable Interpretation of planrung l

Einergency Planning Standard to CTR perate cornmercial nuclear p wer atenda rd (b)(12).

5047 m reactors to develop piens for amergency responses to accidents at their fac6hries, D. Arraorements Beycad A IJst Of avuuascr: The Nudear Regulatory Among those requirements was to CFR w Fa R d Cornmis sion ("NRC" or "Commiulon") 50 47(b)(12)(" planning standard When ortstnally facad with the believes that to CTR SCL47(b)(12) (b)(12)"). which provides: question whether the phresa

(" planning standard (b)(12)") requires (b) Tb ensite and off.r.te emergerry "conta mina ted injured in6viduals" we e pre. accident e*rangernents for medical evepense plan for nudear pc-er reactors services (beyond the maintenance of a intended to encompass. inter che, swet eut the followtng standarda. members of the pubhc m ho, as a rtsult list cf treatment facilities) for MI M*^4emme arv rede for edcal of an accident, were tsposed to Lndividuals who might be severely semen for contaminstad trbred indJvidesta, dangerous levels of raiadnn. the exposed to dangerous levels of offsite Commleston found no explicit and In SoutAren Cohfornia Edison red ation following an accident at a Company et o/. (San Onofre Nudear conclume definition of the phrase in the nuclear power plant. While concluding Centraung Sta t;on. Unita 2 and 31. Cl}. regula don itself or its underlying that plarming standard (b)(12) requires U-10,17 NRC 52a (t GoJ) ("SONCS) documents Nonetheleas the

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w Page 9 of 12 Federal Rep tet / Vol 51. No.180 / Wednesday. September U. ipso / Rules and Regulations 32905 Cornmis sion concluded that tN prudent The minimaily neccesary nsk reducuan purpose of the ne Convnbsion has determined that strengemente for the penon that s ey be the arrangemcots contemplefed ur der Comrnission's regula tions nquired esposed need not be elaborste. As this Statement of Pohey are the interpreting planning standard (b)(12) to pmiously sieted by the Cornrnieston.

apply to such offeite erponed minimum required by a reasonable "lijt wee never the intent of the rtading of plannirig standard (b)lt2).

Indiuduals. given W underlpng reguletiene lo require directly or Accordingly, although implementstion of assurnprion of the NRC's emergency indirectly that etste and local this tesding of the standard ellentall planning regulabons that a servose governments adopt extraordinary some sddinons to, and some accadent muld occur and the rnea sures. eoch ae construction of mo6fications of. the emergency Cornmission presumphon that such an additional hospitals or recruitment of procedarts t.nd organisatiorJ for whech accident could result to offsite subst a nnel additional me 6 cal beerwees are ultimately responsible.the individwals being caposed to danigerous penennel. just to deal with nuclese levels of radiation (a presurnption requireroente of the back6t rule.10 CR plant accidents? U MC at 133.Rather, 50109 (1966). for a cost.benefil analysis concurred in by the Federst Emcrgency the Commission behem that and a fin 6ng that the costs of the hf anspercent Agency). After satisfactory arnngements should mo6fications an justined by a reconsidenton of this matter following include (1) a het of local or regional substantialincreese in safety are oo:

the CUARD decision the Come.lssion medical trestment facihties and apphcable. eloce these mo6firatacca fall has decided to n.smrm this prior transportation prondets appropriately interpretation of p!srtrung standard under the backfit rule's exception for annotated to show their capacities, modifications necessary to bring (b)(12). special capabilities or other unique facihties into cornpliance with a rule of Hon ever, the Cominhision has come charaetenstics. (2) a good faith the Commissiott See 10 CR 50100 to a different result with respect to the reasonsole effort by bcenette or local oc (a)(2) and (a)(4)(1966).The analysis minimum ernngements necessary for state governments to faciblate or obtaln whJch the backLt rule requirts be done indniduals who might be periously wTitten agreements mth the listed to justify the appbcation of any ofits exposed. but not othermise injured. La a med. cal facihties and transportatum exception provisions constitutes the radiol:rg,c emergency. In enginally prouders. O) provision for m bnp core of this Statement of Pobey.See M resolung the scope of arnngemenu available necrasary traic. tag for lesue, the Commission focused on the eme gency respoe.se persecse.1 to In. toterim Cuidance particular needs of o!Taite espo,ed identify. transport. and pronde in its prior statement of policy, the indiudvale for emegener me6 cal emergency first aid to severely exposed Cc-4 ion idemuCed three factors treatment of their radietion injury In indniduals. and (4) a good faath which justihed an isterim pobey of this fashion. the Commission mede a reeionable effort b) bcesacea or state oc ponting appbcA3ts for lud-powTr distinction between the need for '

loce! gesernments to see that Lcense an equitable excepuen to the immediste or neer term medical care, appropriate didis and enerci444 an reqwrements of plar.ning standard w hich was in its nem the goal of conducted which include omulated plann:ng standard (b)ll2). and the need (b)(12] under 10 CR 50 47(c)(1) where sescrely. exposed individuals. If good the appbcant amusfied the requirements for long term rnedical cart. As to feah efforts are not successfulis a of p!anning standard (b)(121 as e sposed indmduals. the Corantission pariscular ca se, the licensee aball found that; integreted by the Com.inission prior to proude or arrartge for adequata the CUARD deesion and cen=Jtted Lhe specja! bassed is proef by the red.stao comperJatory mea sures, consiste.cl with itself to full comphence mth stry esponse to the patient The risfun of the Corn =Jasion's Lettet to W the adhonal nqt.rements bposed by Se t

re d shen %'y is that. =tule n'edcat need for extraord::ary mcJaures noted Cor%r :ssion in response to the CUA.C insie ent eas y tw eve %sUp rmired in a b os e The compersa tory coe s surrs remand State:neet of Fohey oo cases of estnme espm.rn the ponente e e must be approved by NRC. Th.a leve.1 of Erne pncy Plannt:4 5:endard to CTR f unt.k elt to see d emer r) mei, cal caev planning w ould help (1) provide Ifootsw ocutledJ T6e son leme6acy of the 50 4*;o);12). 50 G 27.31 (Ma) Zi 1M4 add uonal assurance of the cooperauors Th e th ree fa ctors w ere. (t) th e tn stre nt reqwed im re t otios enamed indmd 41s p,ov. des onear and ousite of medical facatica,(2) ensure proper pose Whty that the scope of plartnirJ e utkrv.,s4 m:.h an adL.out p.inad af nzne training 13) ensure the as adaba.hty c.! standard (b)(12) =oJd be bruned. (2) transportsuon. and (4) der:onstrate a the pu.b.bly that delay in cor@a w h'y [ "4"# "#

espeb:hry to proude necessary services = sth the poet CUA.M require ments through dNls and e mercues coub be loi sd to be insign ficAnt dwe to Frere thia, the Co=rJulon rea soned that the long terin tru t:nent tweeds of The Cor.mluton hae docted the stag the 10- probabihir of accdenta durvJ exposed tndividuals codd be to develop, consistent eth this the truue: period, a:d (3) the pouibory interpretation of the plantitng standard, of "c'her compel!u'4 rea soss" justJ)v4 adequately met on ed hoc basis.

detsited and specific gudar.ce on the a biief eacepuon wsere appl.caota had After reansideration la baht of the nature of the snedical services to be rehed to >od faith upon pnor CUAM dedators the Comreinion hu e ailable to tiposed Ladmduela and oo Cor %sion knierp etauso o!P lannir4 concluded that sotne a dditional pter.ned the appbcation of plantting standard s ta nc a rd (b)(12l.

artertgements beyond the development (b)!!2) to NRC Ucensees and apphcants in tha Statament of Pobey Loterprutaca of a hat of tnetment f acihties are for heerues to operate com.merdal plare.vg stoods.rd (b)(12) the Decesury to peovide addulonal nuclear power tvsetors The Cocculoc direcas the NTsC sta!! to answance of effectne managemmt of Commission has also directed the staff deveSp (in consuhetiori with TM) emergency medical eerdere in the hours to consider = hether and ur der what and :e eve b) 11/11/M approprate or days following a seven ecodmt crueno ti to neeenary or apprpnete for deta 'ed pidence em the easet contoes However, the Comtrt salon canunute to h t.be et e'I to verify t e o pprepn e tenes s of o f t b

• n e c e s s a ry a r e ag e:m eat s behe n e tha t the long te rm tre a ttne ct in Ag a nd d nlle or e stme e s cons elef t .nh the Cocvr uion,e n e e ds of e spos e d in d m dw ala c.an be a s s oci a t e d with th e h a n dh ,g cf a rv erely detemnation that p'enntng elendard adeqi.ately met on odbot basta. e s pos ed pers c ns. (b)(12! require ana 4ements for medical a

)

A t tG C nra,e rs t i

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, IN 86-98 December 2, 1986 Page 10 of 12 32906 Federal Register / Vol. 51. No.100 / Wednesday, September 17. 1986 / Rufee and Regulations services (beyond the maintenance of a list of pre enisting treatment facilides) for offsite exposed individuals.The Commission believes that the last two fectors, discussed in detail in its May 21.

1985 Statement of Policy, continue to justify reliance on the interim guidance for the period necessary for the NRC staff toissue andlicensees.epplicants, and state and local governments to implement the detailed guldence.

Therefore. until appropnete detailed guidance consistent with thle policy ,

statement le issued and irnplemented, the Ucensing Boards may continue to ,

crosonably find that any hearing j tegarding compliance with to CFR  :

50 4f(b)(u) shall be limited to issues which could have been heard before the Court's decision in CUAAD v.NRC Dated ei Weehington. DC. this 12th dey of i l

/

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September.19es. j .i For the % clear iteguletory Cosumiseson.

Samell. chill, t ,

Secntaryof the Commission. 2

[F1t Dac. es-nosa Filed 6-1648. e 45 aml am i ame Coce rlet 4M .

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. Attachment 1 IN 86-98 m

December 2, 1986 3" p', y , Page 11 of 12

,9y/  : Federal Emergency Management Agency Washington, D.C. 20472 Attachment C November 13, 1986 i

OPERATIVE GUIIRNCE MDORANIR i

Number Date Title 4 4/1/80 Radio Transmission Prequencies and Coverage 5 4/1/80 Agreements Anorg Go/ernmental Ageiwies and Private (Revised- Parties 10/19/83) 8 4/2/80 Regional Advisory Comtittee Coordination with Utilities (Revised-10/19/83) 16 8/7/80 Standard Regional Reviewing and Reportirg Procedures for State and Local Radiological Emergency Response Plans 17 1/8/81 Joint Exercise Procedures 18 5 /2 1 / 81 FEMA Action to Qualify Alert and Notification Syste.s (Pavised- Against RJPE-0654/FDiA-REP-1, Pev.1 10/19/83)-

. . 20 10/19/83 Foreicn Larquage Translation of Public Education Brochures and Safety Messaoes 21 2 /27/84 Acceptance Criteria for Evacuation Plans 22 10/19/83 Recordkeeping Requirerents for Public Meetings 24 4/5/84 Radiological Emergency Preparedness for Handicapped Persons EX-1 7/15/85 Remedial Exercises EX-2 7/15/85 Staf f Support in Evaluating REP Exercises PR-1 10/1/85 Policy on NJREG-0654/FDtA-REP-1 and 44 CFR 350 Periodic Requirements

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e Attachment 1 IN 86-98 December 2, 1986 Page 12 of 12 2

^

IT-1 10/1/85 A Guide to Ibcuments Related to the FIP Program

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PI-1 10/2/85 EDiA Action to Pilot Test Guidance on Public Information Materials and Provide Technical Assistance on Its Use FR-1 12/3/85 Federal Pesponse Center es-: 11/13/86 Medical Services W-2* 11/13/86 Protective Actions for School Children

• GM-21 will be retitled as GM W-1 when it is revised.

t 4

%D JSMEY fg FE8 051987 Southem Califomia Edison Company RECEIVED P O.00x4198 SAN CLEMENTE. CALIFORNIA 92672 rC nuo ;ACatEr p% r^[.V E V F D a

"lf%.UT/"f1~2 January 22, 1987 m ., u. .u.

, z .-

ACM!NISTRAT!ON SCNX:

South Coast Medical Center 31872 Coast Highway South Laguna, California 92677 Attn: Mr. Paul McQuade, Administrator

SUBJECT:

Agreement for Medical Treatment Facilities

Dear Mr. McQuade:

This letter confirms the Agreement between South Coast Medical Center (the " Hospital") and Southern California Edison Company ("SCE")

concerning provision of medical treatment facilities for the general medical treatment of SCE personnel from San Onofre Nuclear Generating Station (the " Station") and emergency medical treatment for other individuals suffering from injuries, injuries complicated by radiation contamination, or excessive radiation exposure as a consequence of I activity at the Station. Staff training and certain equipment to l support the handling of radiation contaminated patients will be

) provided by SCE.

1 i

Confirmation of this Agreement is based on our current understanding that:

I 1. The Hospital has the physical capacity, personnel, medical equipment and resources to handle a radiation contaminated patient as a result of an accident at the Station and is accredited by the Joint Commission on Accreditation of Hospitals (JCAH).

2. The Hospital has or will grant temporary house privileges through i the approp'r~iate procedures as defined by the Medical Staff bylaws to those designated physicians who have their up-to-date credentials and license on file with the Hospital and have contracted with SCE to provide treatment or consultation to SCE personnel and other individuals who have been injured at the Station or individuals from communities in vicinity of the Station who have been exposed to excessive radiations or who have injuries complicated by radioactive contamination as a consequence of a radiological accident at the Station.

Ex. 2

- _ _ _ _ _ _. a

4 South Coast Medical Center January 22, 1987 By executing acceptance of this letter, you confirm these under-standings and agree to provide the following medical treatment services to SCE in support of the operation of the Station:

1. Hospital care and treatment for SCE personnel or other individuals in support of Station operations who have been injured at the Station; or who have been exposed to excessive radiation; or who have injuries complicated by radioactive contamination as a consequence of a radiological accident at the Station.

2. Hospital care and treatment for individuals from communities in the vicinity of the Station injured as a result of activities at the Station, whose injuries may be complicated by radioactive contamination as a consequence of a radiological accident at the Station.

SCE will be responsible for the payment of your reasonable fees and charges for any such services rendered at SCE's request. This Agreement will remain in effect unless terminated by either party giving thirty (30) days advance written notice of termination to the other party.

Please signify your continued agreement to the provisions of this letter by executing the acceptance below and returning this letter to me in the enclosed self-addressed stamped envelope. A copy of this letter agreement is also enclosed for your records.

,Very tr yours, j ~ f,s, ,

t F. C. JACKLEY Manager, Nuclear Affairs and Emergency Planning ACCEPTED AND AGREED TO THIS M DAY OF A/>aAa, 1987 By: nf$Y Adminisfrator AL)

South Coast Medical Center l

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[ GEIVED bil 3 0 a * ,

Southem Cellfomia Edison Company L~.

P O BOX 4198 SAN CLEMENTE. CALsFORNIA 92672 F C SUD JACMLEY ftLapwo t

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January 22, 1987 Mission community Hospital 27700 Medical Center Road Mission Viejo, California 92691 Attn: Mr. George McLay, Executive Director

SUBJECT:

Agreement for Medical Treatment Facilities

Dear Mr. McLay:

This letter confirms the Agreement between Mission Community Hospital (the " Hospital") and Southern California Edison Company ("SCE")

concerning provision of medical treatment facilities for the general medical treatment of SCE personnel from San Onofre Nuclear Generating Station (the " Station") and emergency medical treatment for other individuals suffering from injuries, injuries complicated by radiation contamination, or excessive radiation exposure as a consequence of activity at the Station. Staff training and certain equipment to support the handling of radiation contaminated patients will be provided by SCE.

Confirmation of this Agreement is based on our current understanding that:

1. The Hospital has the physical capacity, personnel, medical equipment and resources to handle a radiation contaminated patient as a result of an accident at the Station and is accredited by the Joint Commission on Accreditation of Hospitals (JCAH).

2. The Hospital has or will grant temporary house privileges through the appropriate procedures as defined by the Medical Staff bylaws to those designated physicians who have their up-to-uate credentials and license on file with the Hospital and have contracted with SCE to provide treatment or consultation to SCE personnel and other individuals who have been injured at the Station or individuals from comunities in vicinity of the Station who have been exposed to excessive radiations or who have injuries complicated by radioactive contamination as a consequence of a radiological accident at the Station.

EX. 3

Mission Community Hospital January 22, 1987 l

By executing acceptance of this letter, you confirm these under-standings and agree to provide the following medical treatment services to SCE in support of the operation of the Station:

1. Hospital care and treatment for SCE personnel or other individuals in support of Station operations who have been injured at the Station; or who have been exposed to excessive radiation; or who have injuries complicated by radioactive contamination Station.

as a consequence of a radiological accident at the

2. Hospital care and treatment for individuals from communities in the vicinity of the Station injured as a result of activities at the Station, whose injuries may be complicated by radioactive contamination as a consequence of a radiological accident at the Station.

SCE will be responsible for the payment of your reasonable fees and charges for any such services rendered at SCE's request. This Agreement will remain in effect unless terminated by either party giving thirty (30) other party.

days advance written notice of termination to the Please signify your continued agreement to the provisions of this letter by executing the acceptance below and returning this letter to me in the enclosed self-addressed stamped envelope. A copy of this letter agreement is also enclosed for your records.

Very tru yours,

- /

F. C. J6CRfNY Manager, Nuclear Affairs and Emergency Planning ACCEPTED AND AGREED TO THIS 9 day , 1987 By: b Exec Miss @#e ionD(Eebtor Community Hospital d

.f 1

Southem Califomia Edison Company PO BOX d 198

$AN CLEMENTE. CALIFORNIA 92672 F. C 8U0" JACMLEY

.... . .". = ve t e .. . , , . . ttLE wo=t

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.~o s weaciac' 'a~~'~a January 22, 1987 San Clemente General Hospital 654 Camino De Los Mares San Clemente, California 92672 Attn: Mr. Thomas W. McClintock, Administrator

SUBJECT:

Agreement for Medical Treatment Facil,ities

Dear Mr. McClintock:

This letter confirms the Agreement between San Clemente General Hospital (the "Hospit.al") and Southern California Edison Company

("SCE") concerning provision of medical treatment facilities for the general medical treatment of SCE personnel from San Onofre Nuclear Generating Station (the " Station") and einergency medical treatment for other individuals suffering from injuries, injuries complicated by radiation contamination, or excessive radiation exposure as a consequence of activity at the Station. Staff training and certain equipment to support the handling of radiation contaminated patients will be provided by SCE.

Confirmation of this Agreement is based on our current understanding that:

1. The Hospital has the physical capacity, personnel, medical equipment and resources to handle a radiation contaminated patient as a result of an accident at the Station and is accredited by the Joint Commission on Accreditation of Hospitals ,

l (JCAH). '

2. The Hospital has or will grant temporary house privileges through  !

the appropriate procedures as defined by the Medical Staff bylaws to those designated physicians who have their up-to-date credentials and license on file with the Hospital and have contracted with SCE to provide treatment or consultation to SCE personnel and other individuals who have been injured at the Station or individuals from communities in vicinity of the Station who have been exposed to excessive radiation; or who have injuries complicated by radioactive contamination as a consequence of a radiological accident at the Station.

EX. 4 m

l

}

4 San Clemente General Hospital January 22, 1987 By executing acceptance of this letter, you confirm these under-standings and agree to provide the;following medical treatment services to SCE in support of the operation of the. Station:

1. Hospital care and treatment for SCE personnel or other individuals in support of Station operations who have been injured at the Station; or who have been exposed to excessive radiation; or who have injuries complicated by radioactive contamination Station.

as a consequence of a radiological accident at the

2. Hospital care and treatment for individuals from communities in the vicinity of the Station injured as a result of activities at the Station, whose injuries may be complicated by radioactive contamination as a consequence of a radiological accident at the Station.

SCE will be responsible for the payment of your reasonable fees and I charges for any such services rendered at SCE's request. This Agreement will remain in effect unless terminated by either party giving thirty (30) days advance written notice of termination to the other party.

Please signify your continued agreement to the provisions of this letter by executing the acceptance below and returning this letter to me in the enclosed self-addressed stamped envelope. A copy of this letter agreement is also enclosed for your records.

i Verytr.u)yyours, i ,g, ' j

/ ' F. C. JACKLEy Manager, N'iclear Affairs and Emergency Planning l

l l

ACCEPTED AND AGREED TO THIS day 0F *

, 1987 By: a_ be ,

Administrator - -

~~%

San Clemente General Hospital l

l ___ _

5

2 Tri-City Medical Center ma,m,,,,, ,,

1 4002 Vista Way, Oceanside, California 92056, (619) 724-8411 Chief Execurne Of5cer l March 11, 1987 %D1Aa(p F. C. Jackley WR.161987 Manager, Nuclear Affairs and Emergency Planning gECEfVED Southern California Edison Company P.O. Box 4198 San Cicmente, California 92672

Dear Mr. Jackley:

Please facilities.

find attached the signed agreement for medical treatment One "the issue for comment is in respect to page (1), paragraph (2),

Hospital has or will grant etc., "as defined by the medical staff temporary house privileges" bylaws" etc. Our records indicate that house privileges. no SCE related physician has been granted temporary find attached Tri-City For your convenience &nd assistance please Medical Center's Medical Staff Bylaws authorizing and facilitating privileges. Tri-City Medical Center encourages SCE to designate and maintain up-to-date credentials and other related~ processes which would expedite patient care.

Tri-City Medical Center maintains an office and staff to assist physicians in this process. Ms. Karen Rennie, Medical Staff Coordinator, telephone number (619) 940-3001, will be happy to assist in this process.

If I can be of any further assistance, please call (619) 940-3357.

Sincerely,

, AA

/ Joseph A. Alborn Assistant Administrator For General Services .

JAA/dd c: R. Hachten, C.E.O.

L. Maas, C.O.O.

K. Rennie, Medical Staff Coordinator 4:47 s

l f *'-s b, h M '

1

. D U P LIC AT E J %D Sou: hem Califomia Edison Company P O 90x 4198 SAN CLEMENTE. CALIFORNIA 92672 manacts mucLtamaar 5

.~ o . -c .cc ~c , n . ~. '

January 22, 1987 #? A se Tri-City Hospital 4002 Vista Way Oceanside, California 92056 Attn:

Mr. Richard A. Hachten II, Chief Executive Officer

SUBJECT:

Agreement for Medical Treatment Facilities

Dear Mr. Hachten:

~~

This

" Hospital") letter confirms the Agreement between Tri-City Hospital (the and Southern California Edison Company ("SCE") concerning provision of medical. treatment facilities for the general medical treatment (the " Station") of SCE personnel from San Onofre Nuclear Generating Station sutfering from injuriesand emergency medical treatment for other individuals injuries complicated by radiation contamination, activity at the Station. or excess,ive radiation exposure as a consequence of Staff training and certain equipment to support by provided theSCE.

handling of radiation contaminated patients will be Confirmation that: of this Agreement is based on our current understanding 1.

The Hospital has the physical capacity, personnel, medical equipment and resources to handle a radiation contaminated patient as a result of an accident at the Station and is accredited (JCAH). by the Joint Commission on Accreditation of Hospitals 2.

The Hospital has or will grant temporary house privileges through the appropriate procedures as defined by the Medical Staff bylaws to those designated physicians who have their up-to-date credentials and license on file with the Hospital and have contracted with SCE to provide. treatment or consultation to SCE l

personnel and other individuals who have been injured at the Station or individuals from- connunities in vicinity of the Station who have.been exposed to excessive radiation; or who have injuries complicated'by radioactive contamination as a consequence of a radiological accident at the Station.

EX. 5

I

, l +

Tri-City Hospital January 22, 1987 By executing acceptance of this letter, you confirm th ese under-services to SCE in support of the operation of the S 1.

Hospital care and treatment for SCE personnel en injured at the Station; or who have been exposed to excessive radiation; or who have injuries complicated by radioactive Station.

contamination as a consequence of a radiological accident at eth 2.

Hospital care and treatment for individuals from communiti the vicinity of the Station injured as a result of acti i es ies inat the Station, whose injuries may be complicated by radio v t active Station.

contamination as a consequence of a radiological accident ateth SCE will be responsible for the payment of your reaso charges for any such services rendered at SCE's request nable fees and Agreement will remain in effect unless terminated by eitherThis party t givingparty.

other thirty (30) days advance written notice of termination o the Please signify your continued agreement to the provisi letter by executing the acceptance below and returning ons of this this l tt ,

me in the enclosed self-addressed stamped envelope. A copy ofe this er to letter agreement is also enclosed for your records .

Very truly yours,

. C. J LEYr Manager, Nuclear Affairs and Emergency Planning ACCETTED AND AGREED TO THIS

[ day OF _, 1987 By:

Ch

/M M Execu e Officer Tr City H pital a

e=(

.e-T

} . . .

6

[  !

Southem Califomia Ed/ son Company P O BOX 4198 SAN CLEMENTE CALIFORNIA 92672 F C HUD'JACMLEY T E L E.PMONE waNaGER NuCLgan AFFarms (7141368 8316 a~o g ue.ct uc, u~~,~

February 4, 1987 John P. Chard, M.D.

657 Camino De Los Mares San Clemente, California 92672

SUBJECT:

Agreement for Physician Services

Dear Dr. Chard:

This letter reconfirms the Agreement between yourself and Southern California Edison Ccmpany ("SCE") concerning the general medical treatment of personnel from the San Onofre Nuclear Generating Station (the " Station") and emergency medical treatment for any individuals suffering from injuries or injuries complicated by radiation contamination as a consequence of '

activity at the Station.

Confirmation of this Agreement is based on our current understanding that:

1. you are a licensed physician qualified to handle medical emergencies, including injuries complicated by radiation contamination.

2. you have access to and may expect the assistance of other medical personnel qualified to handle medical emergencies, including injuries complicated by radiation contamination.

By executing acceptance of this letter, you confirm these under-standings and agree to provide the following medical services to SCE in support of the operation of the Station:

1. Medical treatment to SCE employees in the South Coast area as a company contract physician during normal office hours.

2. Medical treatment of Station personnel at the Station when notified of an emergency when it is inadvisable to transfer the patient to more appropriate medical facilities.

EX. 6 1

p. . < %

John P. Chard, M.D. February 4, 1987  ;

3. Medical treatment of Station personnel at either the San Clemente General Hospital in San Clemente, South Coast Community Hospital in Laguna, Mission Community Hospital in Mission Viejo, or the Tri-Cities Community Hospital in oceanside upon transfer of patients to these facilities.

4. Assistance to SCE in the treatment of SCE personnel or other individuals identified by SCE who have been exposed to excessive radiation or who have injuries complicated by radioactive contamination as a consequence of a radiological accident at the Station.

SCE will be responsible for the payment of your reasonable fees and charges for any such services rendered at SCE's request.

This Agreement will remain in effect unless terminated by either party giving thirty (30) days advance written notice of termination to the other party.

Please signify your continued agreement to the provisions of this letter by executing the acceptance below and returning this letter to me in the enclosed self-addressed stamped envelope. A copy of this letter Agreement is also enclosed for your records.

Very truly yours,

['[

4:: .

F. C. JACKLEY l

Manager, Nuclear Affairs and Emergency Planning D AGREED TO ACCEPTEDgDAYOF THIS d felus m 1987 v

7 sy: MAA M /P. Chard, M.D. '

__ i

o

• I . , r \4 :

l 32 Southem Califomia Edison Company ,

P O BOA d 698

• SAN CLEMENTE. CALsFORN*A 92672 F C BUD - JACMLEY T E Lt *wo~t j

......~oc.....,,.... n..u..u.

.~o .. .cc ac' a' a ~~~c February 4, 1997 Joseph F. Ross, M.D.

Professer of Medicine 12246 Cashmere Street Los Angeles, California 90049

SUBJECT:

Agreement for Physician Services

Dear Dr. Ross:

This letter reconfirms.the Agreement between yourself and Southern California Edison Company ("SCE") concerning the medical consultation services you will provide in support of the operation of the San Onofre Nuclear Generating Station (the

" Station").

Confirmation of this Agreement is based on our current understanding that:

1. You are a licensed physician qualified to handle medical emergencies, including radiation explosure cases as well as injury cases complicated by radiation contamination.

2. You are qualified by education and experience to instruct and train persons on preparing for and responding to the medical consequences of radiation contamination or excessive radiation exposure.

3. You have access to and may expect the assistance of other medical personnel qualified to handle radiation exposure cases or injury cases complicated by radiation contamination.

By executing acceptance of this letter, you confirm these under-standings and agree to provide the following medical services to SCE in support of the operation of the Station l

1. Consultation relative to medical requirements and practices for SCE radiation monitoring personnel.

2. Consultation and assistance to SCE regarding arrangement with medical support facilities and medical personnel to EX. 7

w f .  : .

Joseph F. Ross, M.D. February 4, 1987 handle patients who have been exposed to excessive radiation ,

or who have injuries complicated by radiation contamination.

3. Consultation relative to radiological medical training for SCE and other medical support personnel.

4. Consultation relative to the amount and availability of '

medical resources necessary to effectively deal with the ,

potential offsite consequences of a major release of 1 radiation at the Station.

5. Biannual review of adequacy of SCE and other medical support procedures for care of patients who have been exposed to excessive radiation, or who have injuries complicated by radiation contamination as c. consequence of a radiological accident at the Station.

6. Assistance to SCE in the care and treatment of SCE personnel or other individuals identified by SCE who have been exposed to excessive radiation or who have injuries complicated by radioactive contamination. i

,.- SCE will be responsible for the payment of your reasonable fees and charges for any such services rendered at SCE's request.

This Agreement will remain in effect unless terminated by either party giving thirty (30) days advance written notice of '

termination to the other party.

Please signify your continued agreement to the provisions of this letter by executing the acceptance below and returning this letter to me in the enclosed self-addressed stamped envelope. A copy of this letter Agreement is also enclosed for your records.

) Verytrylyyours, F. C. JACKLEy Manager, Nuclear Affairs and Emergency Planning i

ACCEPT D AND AGREE THIS DAY OF 1987 BY: JM fo WV.glbbd, Pf.DY Y l

.. i s L

j'-((

Southem Califomia Edison Company P O som4198 SAN CLEMENTE CAUFORNIA 92672 F C BUD JACMLEY 'ttE*=o~c

..... . ~ueu...,,... m.,u..,.

. ~o , -i .ce ~ c . . . ~ ~.~ c February 4, 1987 l

Bernard L. Bundy, M.D.

210 Avenida Del Mar San Clemente, California 92672

SUBJECT:

Agreement for Physician Services

Dear Dr. Bundy:

1 This letter reconfirms the Agreement between yourself and Southern California Edison Company ("SCE") concerning the general medical treatment of personnel from the San Onofre Nuclear l Generating Station (the " Station") and emergency medical i treatment for any individuals suffering from injuries or injuries l complicated by radiation contamination as a consequence of l activity at the Station. l l

Confirmation of this Agreement is based on our current understanding that:

1. You are a licensed physician qualified to handle medical emergencies, including injuries complicated by radiation contamination.

2. You have access to and may expect the assistance of other medical personnel qualified to handle medical emergencies, including injuries complicated by radiation contamination.

i By executing acceptance of this letter, you confirm these under- )

standings and agree to provide the following medical services to SCE in support of the operation of the Station:

1. Medical treatment to SCE employees in the South Coast area as a company contract physician during normal office hours.  ;

2. Mesiical, treatment of Station personnel at the Station when l notified of an emergency when it is inadvisable to transfer the patient to more appropriate medical facilities. j 1

I EX. 8

y

.. o

, . ]

r Bernard L. Bundy, M.D. 1' February 4, 1987 i

3. Medical treatment of Station personnel at either the San Clemente General Hospital in San Clemente, South Coast )

I Community Hospital in Laguna, Mission Community Hospital in l Mission Viejo, or the Tri-Cities Community Hospital in oceanside upon transfer of patients to these facilities.

4. Assistance to SCE in the treatment of SCE personnel or other individuals identified by SCE who have been exposed to excessive radiation or who have injuries complicated by radioactive contamination as a consequence of a radiological accident at the Station.

SCE will be responsible for the payment of your reasonable fees and charges for any such services rendered at SCE's request.

This Agreement will remain in effect unless terminated by either party giving thirty (30) days advance written notice of termination to the other party.

Please signify your continued agreement to the provisions of this letter by executing the acceptance below and returning this letter to me in the enclosed self-addressed stamped envelope. A copy of this letter Agreement is also enclosed for your records.

Very truly yours, 7

r F. C. JACKLEY Manager, Nuclear Affairs and Emergency Planning 1

i ACCEPTED AND AGREED E I THIS 7 +h DAY OF Febeus4 1987 l BY: ~~ d L .

Bernard L. Bundy, M.D.

d tvlb U'

r- ,

e ..b COUNTY OF ORANGE INCIDENT RESPONSE PLAN FOR SAN ONOFRE NUCLEAR GENERATING STATION INTERJURISDICTIONAL PROCEDURE NO. 12, ATTACHMENTS 7.6 AND 7.7 EXHIBIT 9

i ATTACHMENT 7.6 DECONTAMINATION SU9 PORT HOSPITALS

( Brea Conamnity Hospital Mission Community Hospital

}

380 W. Central Avenue 27802 Puerta Real .

j Brea, CA 92621 Mission Viejo 92675 j 529 0211 831-2300 (

UC Irvine Medical Center Fountain Valley Community Hospital 101 City Drive South .

17100 E.uclid Avenue -

Orange 92668 Fountain Valley 92708 634-6011 979-1211 Saddleback Community Hospital Fullerton Community Hospital 24451 Via Estrada .

100 E. Valley View Dr. Laguna Hills, CA 92653 Fullerton, CA 92635 837-4500 871-1120 South Coast Medical Center Hoag Memorial Hospital , 31872 Coast Highway 301 Newport Boulevard South Laguna 92677

• Newport Beach 92660 1-499-1311 645-8600 St. Joseph Hospital Huntington Intercommunity Hospital 1100 W. Stewart Drive ' '

17772 Beach Blvd. . Orange 92668 Huntington Beach, CA 92647 633-9111 842-1473 St. Jude Hospital Kaiser Foundation Hospital 101 E. Valencie Mesa Drive -

( ( ,. 441 Lakeview Avenue Fullerton 92632 Ar.aheim 92807 871-3280 998-4400 Tustin Community Hospital La Habra Community Hospital -

14662 Newport Avenue 1251 W. Lambert Road Tustin 92680 La Habra 90631 838-9600 870-5090 West Anaheim Community Hospital La Palma Intercommunity Hospital 3033 W. Orange 7901 Walker St. Anaheim, CA 92804 La Palma, CA 90623 827-3000 l 522-0150 Western Medical Center-Anaheim Martin Luther Hospital 1025 S. Anaheim Blvd.

Medical Center Anaheim, CA 92805 ,

1830 W. Romneya Drive 533-6220 l Anaheim, CA 92803 772-1200 Western Medical Center-Santa Ana 1001 N. Tustin Avenue Mercy General Hospital Santa Ana 92705 2701 S. Bristol Street 834-3555 Santa Ana 92704 754-5454 Westminster Community Hospital 200 Hospital Circle Westminster, CA 92683 i 893-4541

/nm i

EM10-7-13 2-1-83 IP #12 1/C3 EX. 9

, a

i .

ATTACHMENT 7.7 IRRADIATED PERSONNEL PROCEDURES

( ]

1.0 Purpose l

l The purpose of this Attachment is to provide procedures designed to support and amplify responses already provided in:

INTERJURISDICTIONAL PROCEDURE #10 (Reception and Care Centers)

INTERJURISDICTIONAL PROCEDURE fil (Radiological Monitoring and Assessment)

INTERJURISDICTIONAL PROCEDURE #12 (Decontamination)

INTERJURISDICTIONAL PROCEDURE #18 (Medical /Public Health) 2.0 Patient Categories 2.i Three categories of patients are anticipated: .

TYPE DISPOSITION

1. Seriously injured and Treat medically. Transport to irradiated and contaminated. the nearest Decontamination Support Hospital.

II. Not injured (ur minor) but To the UCI Decontamination irradiated and/or conta- Station.

minated.

III. Not injured or irradiated / To the UCI Decontamination

! I contaminated but perceived Station.

irradiated.

3.0 Procedures 3.1 The designated Decontamination Support Hospitals listed in Attachment 7.6 to this INTERJURISDICTIONAL PROCEDURE will be alerted and activated through the Hospital Emergency Administration Radio System (HEARS) for Category I patients. -

3.2 The designated primary Reception and Care Centers will each be staffed with radiological monitoring teams. Those persons determined to be Category 11 patients will be evacuated as soon as possible to the UCI Decontamination Station.

3.2.1 Evacuees directed to the UCI Decontamination Station will be interviewed, monitored, and treated in accordance with the provisions specified in this INTERJURISDICTIONAL PROCEDURE. Persons suspected of having radiation sickness will have blood samples taken and receive other treatment as determined by medical personnel. These patients rey oe evacuated to an available Decontamination Support Hospital

. for further evaluation and treatment.

I

/nm EM10-7-14 2-1-83 IP #12 1/83

3.3 Category III patients must be classified and evaluated to prevent )

any undue concern or anxiety among the general public. Those persons should be evacuated to the UCI Decontamination Station if they are creating any difficulties or disruption to the activities of the center.

3.4 Additional requirements for assistance with radiological monitoring teams or physician support can be obtained by a request to the E0C. Southern California Edison is prepared to assist in the screening and classification effort by providing Mobile Whole Body Counters (3600#) as requested by the E0C to the SONGS EOF.

(A 24-hour lead cime is required) 4.0 Personnel, Equipment and Supplies The UCI Decontamination Station will be equipped with sufficient quantities of those items listed on Attachment 7.1 to this INTERJURISDICTIONAL PROCEDURE to process 250 irradiated / contaminated persons per hour.

5.0 Responsibilities 5.1 Orange County Agencies 5.1.1 Emergency Management Division - Ccordinate personnel, equipnent and supplies procurement and readiness. Coordinate operation of decontamination and treatment facilities.

Train radiological monitors and hospital personnel. ,

5.1.2 Orange County Fire Department - Provide locally or through Mutual Aid agreements sufficient radiological monitors.

Develop personnel and equipment requirements.

5.1.3 HCA/ Environmental Health - Provide services to other parties concerned with nuclear radiation exposure and measurement. Assist in training radiological monitors.

Develop personnel, equipnent, and supply requirements.  !

1 5.1.4 CAO, Public Information - Promote and coordinate timely I radiation and casualty information releases to the EBS and j news media.

5.1.5 HCA/ Emergency Medical Services - Coordinate the support required to implement the procedures contained in this INTERJURISDICTIONAL PROCEDURE. See also INTERJURISDICTIONAL PROCEDURE #18 (Medical /Public Health).

1 5.1.6 HCA/ Mental Health - Provide qualified personnel to support I the Decontamination Station at UCI. j

- l 5.2 State Agencies J 5.2.1 OES - Coordinate the provision of decontamination equipment from state and federal agencies. ,

EM10-7-15 2-1-83 IP #12 1/83

~

(

5.3 bCI - Provide space and utility services for the Decontamination 3tation. Develop personnel, equipment, and supply requirements.

5.4 Red Cross - Conduct initial interviewing of evacuees arriving at R&C Centers. Assist in recording of the status and location of persons exposed to significant levels of radiation, the collection of baseline blood samples if required. Coordinate the arrangements of the R&C Centers, and the movement of people in and out of those Centers.

5.5 Southern California Edison - Be prepared to furnish the services of nuclear-trained medical professionals and equipment.

)

~

/nm EM10-7-16 12-29-82 1/83 IP #12

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SAN DIEGO COUNTY NUCLEAR PLANT EMERGENCY RESPONSE PLAN, STANDARD OPERATING PROCEDURE NO. 12, ATTACHMENT 6 EXHIBIT 10 l

i l

SAN DIEGO COUNTY i

6 DECONTAMINATION SOP #12 ,

i 1

I 1.9 PURPOSE l

1.1 This procedure provides guidance and information (

j concerning the decontamination of:

1 1.1.1 Emergency workers 5 I

l.1.2 General population )

1.1.3 Vehicles 1.1.4 Areas s i

1 1.1.5 Foodstuffs d

2.0 REFERENCES

2.1 San Diego County Nuclear Power Plant Emergency Response Plan.

, 2.2 AEC Manual TID-24919, Radiological Emergency Op-erations.

2.3 Decontamination of Nuclear Reactors and Equipment, J.A. Ayres.

2.4 EPA-529/1-75-991, Manual of Protective Action Guides and Protective Actions f or Nuclear Incidents.

2.5 Department of Defense Manual SM-ll.22.2, Radiological Defense Textbook, March 1963.

3.9 RESPONSIBILITIES 3.1 Radiological Protection Officer (RPO), ODP 3.1.1 Coordinate the planning and implementation of decontamination.

3.2 Oceanside Fire Department

- 3.2.1 Provide four two-member personnel monitoring teams.

I 4.9 PRECAUTIONS SOP #12-1 EX. 10

r "

8 s * *

• i 4.1 General (

4.1.1 When monitoring a surface for contamination, locate the. detector face about 1/2-inch from the surface and move the detector over the surface slowly enough to give ,

the instrument time to respond.

4.1.2 Perform decontamination of localized areas carefully, to prevent the spread of contamination to lesser contaminated or uncontaminated areas. Highly contaminated areas should be decontaminated first.

4.1.3 Wear protective clothing and respiratory

' protective equipment, as needed when performing decontamination.

4.1.4 Survey frequently to determine the ef-factiveness of decontamination. Consider ceasing decontamination or changing methods when successive surveys show a minimal decrease in contamination levels.

4.1.5 Collect solid waste which is potentially contaminated for later disposal.

4.2 Personnel 4.2.1 Prior to decontamination, inspect skin areas for minor wounds such as cuts and abrasions. If any are found, they should- be protected from becoming either contaminated or more contaminated during the process.

4.2.2 Discontinue immediately any decontamination agent or method which appears to cause skin reddening or irritation.

4.2.3 Exercise caution during the decontamination process to prevent potentially contaminated liquids from entering body openings.

4.2.4 The temperature of any water used should be slightly warm.

I SOP #12-2

m

. / ,

5.0 EQUIPMENT AND SUPPLIES l 5.1 Decontamination equipment and supplies are listed i in Attachment 1. ,

5.2 Equipment and supplies are stored at Oceanside Fire Department and ODP.

6.0 PROCEDURE 6.1 Personnel' decontamination 6.1.1 Emergency workers will be monitored, using the techniques outlined in Attachment 2.

6.1.2 The general population will be monitored -

for contamination, initially on a random baris, at the Rest Stop south of SONGS

, on I-5, using the techniques outlined

, in Attachment 2. Additional monitoring and decontamination will take place at designated reception and mass care centers, if required.

6.1.3 If contamination which exceeds the limits shown in Attachment 3 is detected on

, any individual's clothing, the clothinc

'. will be collected and bagged for later disposal. The clothing and contamination levels will be recorded in the applicable portion of a Personnel Decontamination Record form (see Attachment 4). Substitute clothing will be provided.

6.1.4 If contamination which exceeds the l'imits shown in Attachment 3 is detected on any individual's skin, decontamination is recommended. Attachment 5 provides '

guidance for decontamination techniques.

Contamination levels and the decontamination effort will be recorded in the applicable section of a Personnel Decontamination Record form (see Attachment 4).

6.1.5 Decontamination support will be available at the hospitals listed in Attachment 6.

. 6.2 Vehicle Decontamination 6.2.1 Vehicles suspected of being contaminated SOP #12-3 m.. .._ ._ .. .._.

.. ......m.. . . . . . . . ... .

. . . . . . . . . . . - . . . . . . , , _ . ....s

r m.

l li' I.

will be monitored internally and externally for contamination at such location as the RPO may designate using the techniques (

outlined in Attachment 8. These surveys will be performed on an occasional, n' random basis, as determined by the RPO, consistent with Department of Health Services, Public Health Services pronounce-ments and with the existing contamination a

conditions which have been determined l' by survey.

6.2.2 If contamination which exceeds the limits shown in Attachment 3 is detected on any external vehicle surface, an attempt should be made to decontaminate using soap and water in an area approved by ~

the RPO. All decontamination efforts t will be recorded on a vehicle Decontamination Record form (see Attachment 9).

6.2.3 If contamination which exceeds the limits show.2 in Attachment 3 is detected on any internal vehicle surface and the contamination is low-level and spotty, an attempt should be made to decontaminate using methods such as tape presses and

,. damp rags. All decontamination efforts  ;

will be recorded on a Vehicle Decontamination Record form (see Attachment 9).

6.2.4 If a vehicle with internal contamination cannot be successfully decontaminated or there are no resources readily available for decontamination and the vehicle is required for emergency use, consideration should be given to covering the contaminated areas with a clean covering such as plastic sheeting and requiring the occupants to wear protective cir..hing.

6.2.5 Contaminated vehicles which cannot be decontaminated, and are not essential for emergency service, should be impounded for further evaluation.

6.3 Building,and Area Decontamination 6.3.1 The decontamination of large land aress and building surfaces, if required, will occur as part of the general recovery pha se . The degree of decontamination SOP #12-4 o a.

'*pA

-_ LL_i ' . . -

needed will depend on the extent and severity of contamination and on the i type of surf ace (s) which is contaminated.

6.3.2 General decontamination methods'and some approximate efficiencies are shown i in Attachment 10.

6.3.3 If large land areas are contaminated, more severe methods, such as earth removal or plowing-under contaminated soil may have to be considered.

6.4 Foodstuffs 6.4.1 Public advisories on decontamination of foodstuffs will be provided by the County Health Officer.

6.4.2 The primary methods for decontamination of foodstuffs are washing, brushing, peeling or boiling.

6.4.3 Although not a direct contamination removal process, time delays (to permit the decay of short-lived radioactivity on foodstuffs) may be considered. Such q '

delays are accomplished by such processes

'. as refrigeration, canning, freezing and dehydration.

6.4.4 Foodstuffs may be diverted into another food product which can be consumed at a later date or used as animal feed.

6.4.5 If attempts to decontaminate foodstuffs either by direct removal, time delays, or diversion are unsuccessful, foodstuff isolation and condemnation by County and State agencies may be required.

ATTACHMENTS Attachment 1 - Personne) Decontamination Station Equipment and Supplies Attachment 2 - Personnel Contamination Survey Techniques Attachment 3 - Beta-Gamma Contamination Limits Attachment 4 - Personnel Decontamination Record SOP #12-5

~~

i, i .

1 Attachment 5 - Personnel Decontamination Techniques Attachment 6 - Decontamination Support Hospitals Attachment 7 - Reception and Mass Care Centers Attachment 3 - Surface Contamination Survey Techniques Attachment 9 - Vehicle Decontamination Record Attachment 10 - Decontamination Method Efficiency I

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1 Attachment 6 COUNTY OOP ,

DEPARTMENT OF HEALTH SERVICES, PUBLIC HEALTH SERVICES NOTE: If needed, the following San Diego County Hospitals are equipped to handle contaminated patients:

Primary:

Tri-City Hospital Scripps La Jolla Palomar Hospital secondary:

Mission Bay Memorial Fallbrook

' 'i Clairemont General El Cajon Valley i l

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f"4 3' Southern California Edison Company P O Box 4198 S AN CLE ME'N T E C ALIFORNI A 926 72 F C BUD JACKLEY ' ELE *"ONE 1 wa~aGaa ~ucir an er e aims 87 ' al 368 8 3 ' e l a ~ o w, ~ c.c ~ c , ,< a ~.~ c January 22, 1987 Dr. Bruce Tovar Scudders Ambulance Company 25260 East La Paz Road, Suite 4 Laguna Hills, California 92654

SUBJECT:

Agreement for Transportation of Injured or Contaminated Individuals Gentlemen:

This letter reconfirms the Agreement between Scudders Ambulance Company (" Company") and Southern California Edison Company ("SCE")

concerning the transportation of injured individuals to treatment facilities outside the site boundary of San onofre Nuclear Generating Station (the " Station"). Confirmation of this Agreement is based on our current understanding that:

1. The Company is duly licensed and operated under the laws and regulations of the State of California.

2. The company has the capability of handling the normal range of medical emergencies, including an injury complicated by radiation contamination.

3. The Company has the capability of promptly providing to injured persons emergency medical technician care and transportation from the Station or surrounding communities to appropriate medical treatment facilities, including San Clemente General Hospital, South Coast Community Hospital, Tri-City Community hospital, or i Mission Community Hospital.

1 EX. 11

Scudders Ambulance Company January 22, 1987 By executing acceptance of this letter, the Company confirms these understandings and agrees to provide the following services to SCE in support of the operation of the Station:

1.

Transportation of SCE personnel or other individuals suffering from injuries including injuries complicated by radiation contamination as a result of activities at the Station from the Station or its vicinity to appropriate treatment facilities as directed by SCE.

2. Emergency care for such individuals enroute to the treatment facility.

SCE will be responsible for the payment of your reasonable fees and charges for any such services rendered at SCE's request. This Agreement will remain in effect unless terminated by either party giving thirty (30) days advance written notice of termination to the other party.

Please signify your continued agreement to the provisions of this letter by executing the acceptance below and returning this letter to me in the enclosed self-addressed stamped envelope. A copy of this letter agreement is also enclosed for your records.

Very trulyj yours, F. C. JACKLEy

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Manager, Nuclear Affairs and Emergency Planning ACCEPTED AND AGREED TO THIS d DAY OF k , 1987 BV ' -

A General Manager Scudders Ambulance Company

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r~:CbY Southem Califamia Edison Company P O Box 4198 SAN CLEMENTE CALirORNLA 92672 F C HUD JACMLEY - M L E PHONE waNaGtp hvC L t an ar e a ef, U '954' 3+e 6 3 ' e

. ~ o . . . c , ~ c , u . ~ ~ ,,<, March 23, 1987 M.C#Lg,,

MR.3:0 ygy E

CElvgg Med Air Flight Operations p.O. Box C-11912 Santa Ana, California 92711

SUBJECT:

Agreement for Transportation of Injured or Contaminated Individuals Gentlemen:

This letter reconfirms the Agreement between Med Air, a California Corporation, (" Company") and Southern California Edison Company

("SCE") concerning the transportation of injured individuals to treatment faci 3ities outside the site boundary of San Onofre Nuclear Generating Station (the " Station"). Confirmation of this Agreement is based on our current understanding that:

1. The company owns a helicopter air ambulance service which is operated by HOSPITAL AIR TRANSPORT, Inc. (" HAT") an Oregon Corporation. HAT is duly licensed to operate such service in California.

2. The medical flight team has the capability of handling the normal range of medical emergencies, including an injury complicated by radiation contamination.

3. The Company has the capability of promptly providing to injured persons emergency paramedical care and transportation from the Station or surrounding communities to appropriate medical treatment facilities, including San Clemente General Hospital, South Coast Community Hospital, Tri-City Community Hospital, or Mission Community Hospital. Such capability is subject to the availability of an aircraft which availability will be determined solely by Med Air.

EX. 12

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- u Med Air March 23, 1987 By executing acceptance of this letter, the Company confirms these understandings and agrees to provide the following services to SCE in support of the operation of the Station

1. Transportation of SCE personnel or other individuals suffering from injuries (including injuries complicated by radiation contamination) as a result of activities at the Station from the Station or its vicinity to appropriate treatment facilities as directed by SCE, subject to availability of an aircraft.

2. Emergency care for such individuals enroute to the treatment facility.

3. It is understood that HAT, as operator of the MED AIR program, shall have the sole right and obligation to determine whether or not a given flight requested by SCE should be made and how such flight should be. conducted from ,

the standpoint of weather cond tions, or perceived danger to flight crew. (or aircraf t safety) $.

SCE will be responsible for the payment of your transportation and medical services fees and charges for any such services rendered at SCE's request to Med Air or its sub-contractors. SCE will make such payments within 30 days of date of invoice. This Agreement will remain in effect unless terminated by either party giving thirty (30) days advance written notice of termination to the other party.

Please signify your continued agreement to the provisions of this letter by executing the acceptance below and returning this letter to me in the enclosed self-addressed stamped envelope. A copy of this letter agreement is also enclosed for your records.

Very truly yours Ff C. JACKLEY' Manager, Nuclear Affairs and Emergency Planning ACCEPTED AND AGREED TO THIS 26thphy 07 March , 1987 BY: JA> edw Med' Air,'a California Corporation Betty Belden, President

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1. ACTION OF THE CITY COUNCIL OF THE I CITY OF SAN CLEMENTE, CALIFORNIA Addressed to: DIRECTOR OF FIRE PROTECTION Copy to: CITY MANAGER vsUD JACKLEY, NUCLEAR AFFAIRS AND EMERGENCY PLANNING Council Meeting Date MAY 6, 1987 Present: COUNCIL MEMBERS - LIMBERG, LORCH, MECHAM, MAYOR VEALE Absents COUNCIL MEEBERS - RICE Agenda Item No.: 4-C Subiect: Acreement with Southern California Edison Company -

Transoortation of Iniured Contaminated Citizens Following clarification, MOTION BY COUNCILMEMBER LORCH,-

SECOND BY COUNCILMEMBER LIMBERG, CARRIED 4-0 (COUNCILMEMBER RICE ABSENT), to approve and authorize the Mayor to execute the agreement with Southern California- Edison- Company to provide training and supplies to the San Clemente Fire Depart-ment, as well-as reimburse the City for the transportation costs for citizens who are provided emergency medical assis-tance during a nuclear accident at SONGS.

. STATE OF CALIFORNIA )

COUNTY OF ORANGE ) SS.

CITY OF SAN CLEMENTE )

I, MYRNA ERWAY, City Clerk and ex-officio Clerk of the City Council of the City of San Clemente, California, do hereby certify the foregoing to be the official action taken by the City Council at the above meeting.

IN WITNESS WHERE'OF, I have hereunto set my hand and seal this 12th day of May, 1987.

(SEAL) t) h M4/M City Cle@l and ex-of'ficio Cl(fk of the Cny Council t '

EX. 13

e.

F AGREEMENT THIS AGREEMENT (" Agreement") is entered into this 6th day of May, 1987 (the " Effective Date"), by and between the City of San Clemente (" City"), a municipal corporation, and the Southern California Edison Company ("SCE"), a California corporation, and is based upon the following:

RECITALS WHEREAS, the Nuclear Regulatory Commission ("NRC") has promulgated regulations requiring emergency planning in the vicinity of nuclear power plants (10CFR50.47); and WHEREAS, NRC regulations at 10CFR50.47(c)(2) require emergency planning be implemented in the area about ten miles in i radius from a nuclear facility; and l WHEREAS, the City of San Clemente is located within a ten mile radius of the San Onofre Nuclear Generating Station

(" SONGS"), which facility is subject to the NRC regulations contained in 10CFR50.47; and WHEREAS, specialized training and materials would aid the San Clemente Fire Department in responding to injuries resulting from the unlikely event of an accident at SONGS; and, WHEREAS, it is in the interest of the health, safety and general welfare of the citizens of the City of San Clemente that the City participate with SCE, the manager of SONGS, in developing plans to provide emergency medical assistance in the unlikely event of an accident at SONGS; NOW, THEREFORE, in consideration of the mutual covenants, conditions, promises and terms contained herein, the t parties hereby agree as follows:

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1. PROVISION OF SERVICES.

1.1 Transportation of Injured Subject to the limitations of manpower and equipment, the Fire Department of the City of San Clemente shall endeavor to provide emergency medical assistance to any individual suffering j from injuries, injuries complicated by radiation contamination, or excessive radiation exposure within the City limits of the City of San Clemente as a consequence of a General Emergency at SONGS. Such assistance shall include emergency aid to individuals suffering from injuries complicated by radiation contamination or exposure, and the transportation of those individuals to the closest available hospital.

2. TERM.

2.1 Initial Term The Initial Term of this Agreement shall commence on the 6th day of May 1987, and shall continue until June 30, 1990, unless terminated in the manner provided in paragraph 5.

2.2 Renewal Term Subject to paragraph 5 below, either party shall have the right to extend this Agreement for an additional three (3) year term. In order for such extension to be effective, the party electing to extend shall provide the other party with written notice indicating its exercise of this option to extend not less than one (1) month nor more than six (6) months prior to the end of the Initial Term.

A 3. COMPENSATION.

3.1 Per-Call Charge SCE shall pay the City for services provided pursuant to Section 1.1 of this Agreement, based upon a per-call charge, I calculated under the " Fee Schedule" approved by Resolution of the City Council of the City pursuant to Chapter 20, Article 2, Sections 20-12 through 20-14 of the Code of the city of San Clemente, as such fee schedule currently exists or as it may hereafter be adjusted. SCE shall cause such payments to be made to the City within fifteen (15) days after receipt of City's invoice.

4. TRAINING, MATERIALS AND EQUIPMENT.

4.1 Training SCE shall institute a periodic training program for' all First Responders employed by the San Clemente Fire Department.

Such training shall cover the transportation and care of contaminated individuals. Such training shall commence within six (6) months of the Effective Date of this Agreement.

4.2 Materials SCE shall provide the City with the materials and supplies necessary to care for the injured contaminated individuals during transport to a hospital facility.

4.3 Equipment Maintenance SCE shall decontaminate all City equipment contaminated as a result of the provision of services under this Agreement.

SCE shall replace any of such equipment or any part thereof that cannot be decontaminated.

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, 5. TERMINATION.

5.1 Cancellation Either party may terminate this Agreement by giving the other_ party thirty (30) days advance written notice.

5.2 Payment Upon Cancellation SCE shall pay the City all amounts dus and payable

'under this Agreement no later than seven (7) calendar days after cancellation of this Agreement.

6. LIABILITY.

6.1 Liability for Breach SCE's sole remedies for any breach of this Agreement by the City shall be the termination of-the Agreement. Under no circumstances shall the City be liable to SCE, its agents or employees, for.any damages arising out of the City's breach of this Agreement.

6.2 No Third Party Beneficiaries This Agreement does not create any additional obligation upon the City to persons not a party hereto, nor does it create any third party beneficiaries.

7. liIJCELLANEOUS PROVISIONS.

7.1 Prohibition Against Assignment Neither party shall assign any interest in this Agreement, nor shall any party transfer any innerest in the same without the prior written consent of the other. Any attempt to assign any rights under this Agreement in any other manner shall be null and void.

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7.2 Integration This Agreement represents the entire understanding of the parties as to those matters contained herein. No prior oral or written understanding shall be of any force or effect with respect to those matters covered by this Agreement. This I Agreement shall be governed by the laws of the State of California and construed as if drafted by both parties. This Agreement may not be modified, altered or amended except in writing by the parties.

IN WITNESS WHEREOF, the parties have executed this Agreement in one or more counterparts which, taken together, shall constitute one Agreement as of the date first written above.

SOUTHERN CALIFORNIA EDISON COMPANY Date: 41 3 M

.}' Yl B F.'C. Jackl M anager Nuclear Affairs and Emergency Planning CITY OF SAN CLEMENTE Date: [Maa.[/,/987 g '

By M O-u Approved as to form: Attest:

/s/ Jeff Oderman QW Mhh City Attorney City City erk San Clemente g

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COUNTY OF ORANGE INCIDENT RESPONSE PLAN FOR SAN ONOFRE NUCLEAR GENERATING STATION INTERJURISDICTIONAL PROCEDURE NO. 9 (TRANSPORTATION)

EXHIBIT 14

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.L ORANGE COUNTY INTERJURISDICTIONAL PROCEDURE #9 (TRANSPORTATION) 4 1

1.0 PURPOSE '

1.1 This procedure provides for evacuation of residents from a general area as a result of an emergency incident at the San Onofre Nuclear Generating Station requiring the movement of:

1.1.1 Patients at medical facilities, 3 1.1.2 Students in schools, 1.1.3 Residents of extended care facilities. .

1.1.4 Residents and transients without available transportation, and 4

1.1.5 Incapacitated or handicapped persons at their place of  !

residence.

1.2 This Procedure:

1.2.1 Defines Transportation Officer and transportation agency responsibilities.

1.2.2 Identifies available transportation equipment.

2.0 REFERENCES

2.1 State of California, Nuclear Power Plant Emergency Response Plan (Revised March 1981) 2.2 Incident Response Plan for San Onofre Nuclear Generating Station (January 1983) 2.3 INTERJURISDICTIONAL PROCEDURE #4 (Notification) 2.4 INTERJURISDICTIONAL PROCEDURE #7 (Emergency Coninunications) 2.5 INTERJURISDICTIONAL PROCEDURE #8 (Evacuation / Sheltering) 2.6 California Highway Patrol Disaster Plan, Chapter VI, Border Division Nuclear Response Plan 2.7 Emergency Response Information for Sar. Onofre Nuclear Generating Station (Second Edition) September 1982

/nm EM10-5-1 I

2-1-83 IP #9 -1 1/83 EX. 14

'- 1 3.0 RESPONSIBILITIES i 3.1 Operational Area Coordinator in conjunction with jurisdictional officials and SCE will cetermine:

3.1.1 That an evacuation is required, and 3.1.2 The evacuation area involved.

1 3.2 The Transportation Officer, County of Orange, will:

3.2.1 Maintain lists of transportation equipment available for evacuation within the jurisdiction's area of responsi-bility, 3.2.2 Maintain current estimate of persons who require evacuation t ransportation, -

3.2 3 Designate routes to be used to bring equipment into the risk area in coordination with CHP, CALTRANS, and Orange County Sheriff, 3.2.4 Obtain commitment from transportation agencies for use of equipment in emergency situations, 3.2.5 Designate number and type vehicles to proceed to each Assembly Point and to each Special Institution, 3.2.6 Designate transportation equipment to pick up incapacitated persons at places of residence, based on current listing

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of such persons, and -

3.2.7 Notify agencies responsible for providing transport equipment of specific requirements for thc evacuation.

3.3 Orange County Transit District has 300 buses available for use and will:

3.3.1 Ensure vehicles are fueled and operators available, 3.3.2 Provide operators with maps showing evacuation routes and pickup locations, and 3.3.3 Direct operators to proceed to assembly points by identi-fled routes involving minimum interference with outgoing traffic flow.

3.4 The Capistrano Unified School District has buses available for use in evacuating school children. See Attachments 6 through 14 to INTERJURISDICTIONAL PROCEDURE #8 (Evacuation / Sheltering) for listings of schools by evacuation districts.

/nm EM10-5-2 2-1-83 ( '

IP #9 1/83 l

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y-4.0 PRECAUTIONS 4.1 This INTERJURISDICTIONAL PROCEDURE supports INTERJURISDICTIONAL PROCEDURE #8 (Evacuation / Sheltering) "nhich contains special coordinating and transportation service requiremcnts.

4.2 See Reference 2.6 for CHP traffic control measures that are automatically established at GENERAL EMERGENCY. Traffic congestion at these points may impede buses and ambulances attempting to enter the EPZ at tes a GENERAL EMERGENCY has been declared.

5.0 EQUIPMENTANDSUPPL!$(

5.1 OCTD buses and support equipment 5.2 CUSD buses 5.3 Available on request:

5.3.1 Paramedic ambulances 5.3.2 Hospital ambulances 5.3.3 Commercial ambulances 5.3.4 Commercial buses 5.3.5 Commercial taxis and limousines 5.3.6 AMTRAK passenger trains 5.3.7 California National Guard vehicles and helicopters 5.3.8 U. S. Marine Corps vehicles and helicopters 5.3.9 U. S. Coast Guard and Coast Guard Auxiliary vessels 6.0 PROCEDURE

( 6.1, When a decision to evacuate a specific area has been made, the Operational Area Coordinator will direct thet transportation assets be deployed to assist in the movement.

6.2 The Transportation Officer will determine specific transportation and special equipment requirements based on analysis of current information.

6.3 Special Institutions will be queried by telephone to determine the exact number of persons to be transported and special equipment required for evacuation. In addition, similar calls may be made to the residences of incapacitated persons to confirm transportation requirements. If time does not permit t elephone calls, previously determined average personnel densities will be the basis for ordering transportation assets at specific locations. See INTERJURISDICTIONAL PROCEDURE #8 (Evacuation / Sheltering).

6.4 The Emergency Public Information Officer (EPIO) will ensure that pubite announcements have been broadcast concerning evacuation procedures and timing. Special Institutions will be notified by telephone.

6.5 The Transportation Officer will contact Orange County Transit District with specific requests for vehicles and special equipment.

/nm 4 EM10-5-3 2-1-83 IP #9 1/83

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6.6 Status reports on the evolving evacuation process will be proviced to the EOC by law enforcenent and traffic control personnel.

Developing transportation problems at Special Institutions and {

Assembly Points will be given priority attention by the Transpor-tation Officer. Requests for additional transportation assets and/or redistribution of dispatched vehicles are to be anticipated.

6.7 Following abatement of the hazard, transportation support for re.

entry will be provided as required. The Transportation Officer will use similar planning techniques and transportation assets to return evacuees to homes and Special Institutions, when so directed.

7.0 ATTACHMENTS None

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/nm EM10-5-4 2-1-83

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IP #9 4-1/83 4

r SAN DIEGO COUNTY NUCLEAR PLANT EMERGENCY RESPONSE PLAN, STANDARD OPERATING PROCEDURE No. 9 (TRANSPORTATION)

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( TRANSPORTATION SOP #9 1.0 PURPOSE  !

1.1 Any evacuation of residents and transients as a result'of an emergency incident at SONGS would l require special arrangements for transportation.

1.2 San Diego County has no personnel under its juris-diction who would be subject to evacuation from the 10-mile Emergency Planning Zone (EPZ) . . Therefore, no special transportation arrangements are required. 1

2.0 REFERENCES

2.1 San Diego County Nuclear Power. Plant Emergency Response Plan. j 2.2 California Master Mutual Aid Agreement.

3.0 RESPONSYBILITIES

( 3.1 The Director, ODP will ensure that an adequate and current inventory of available transportation assets, particularly bus and ambulance, is main-tained.

3.2 The EOF Liaison Representative will coordinate with other offsite representatives in determining transportation assistance requirements, and will provide requests for transportation assistance to the EOC.

l SOP #9-1 EX. 15 l

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THE HANDLING AND TREATMENT OF RADIOACTIVELY CONTAMINATED AND INJURED' PATIENT (S) by EMERGENCY DEPARTMENT PHYSICIANS AND NURSES Prepared for TRI-CITY HOSPITAL Oceanside, California l

Prepared by Nuclear Affairs and Emergency Planning j and Mesa Medical Department i San Onofre Nuclear Generating Station SOUTHERN CALIFORNIA EDISON COMPANY P.O. BOX 4190 San Clemente, California 92672 l

June 5, 1987 8:00 a.m. - 12:30 p.m.

EX. 16-

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HANDLING OF RADIOACTIVELY CONTAMINATED AND INJURED PERSON (S) AT A NUCLEAR POWER PLANT by Emergency Medical Personnel i AGENDA i

TOPIC TIME PURPOSE INTRODUCTION 10 minutes Introduce SCE staff and their (Lecture) roles; provide an overview of the course and explain the need for special procedures when dealing with an injured and contaminated patient. .

REVIEW OF 30 minutes Review the medical aspects of RADIATION BIOLOGY (Lecture / radiation injuries, exposure /

Slides) effect relationships.

DETECTING AND 20 minutes Review radiation protection MEASURING (Lecture) principles, describe and RADIATION demonstrate use of radiation survey instruments.

BREAK 10 minutes HOSPITAL EMERGENCY 25 minutes Review a hospital procedure DEPT. RESPONSE TO (Video) for managing a radiation RADIATION ACCIDENTS accident victim.

HOSPITAL RESPONSE 60 minutes Introduce Hospital ER staff PROCEDURES (Lecture) and their roles; provide participants with opportunity to demonstrate knowledge to review their hospital's procedure for managing the radiation accident victim.

BREAK 10 minutes SPECIFIC ELEMENTS 60 minutes Demonstrate partial REA set OF RESPONSE (Demonstra- up, use of protective tion / Parti- clothing, dosimetry and steps cipation) in management of the conta-minated patient; mini-drill.

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i LECTURE OUTLINE l Introduction / Overview 0 Introduction of SCE staff O Review need for special procedures for response to the injured and contaminated O Hospital response objectives O Purpose of training / overview of lecture i

Classification of Radiation Accidents O External exposure O External contamination, internal contamination O Combined: injury and contamination, external exposure O Hospital response to accidents o Triage o Assessment antl treatment o Decontamination Case Studies O Actual incidents involving a contaminated and injured patient O Define medical response o At nuclear plant o At support hospital 4

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I Procedures for response to the injured and contaminated patient O Response procedures for treating the injured and i contaminated patient l O Hospital Administrative Procedures i'

O Internal Notification Procedures O Department Responsibilities O Notification and Verification of Contaminated-Injured to be Received by the Hospital O Role of the Plant Health Physicist O Function and Use of Dosimetry O -Gowning Procedure O Decontamination and Sample Taking Kit o Contents and Use o Sample Taking Procedure O Resuscitation and Stabilization of the Patient O Contamination Control Techniques O Documentation and Record-Keeping O Patient Care O Patient Exit Procedures o Attendant Exit Procedures O Clean-Up of the REA l

146.txt f

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THE HANDLING OF THE RADICACTIVELY CONTAMINATED AND INJURED PERSON AT A NUCLEAR POWER FACILITY l BY EMERGENCY DEPARTMENT PHYSICIANS AND NURSES )

OBJECTIVES At the completion of this training, emergency department personnel will be able to: j

1. Explain the difference between exposure and contamination and state when an individual from San Onofre Nuclear Generating Station should be treated in the specially prepared radiation emergency area.

2. Explain the difference between dose and dose rate and briefly summarize the relationships between dose and biological effect.

3. Compare a given radiation injury exposure to (a) background and to (b) a chest x-ray.

4. List 3 protective actions that can reduce exposure from ionizing radiation.

5. Describe the set up of the Radiation Emergency Area (REA).

6. Briefly discuss the role of the various members of the response team: physicians, nurses, administrative personnel, security, housekeeping and maintenance, health physics personnel, data clerk, and hospital public relation and information system.

7. Demonstrate the correct use of protective clothing and dosimetry.

8. List the samples that are needed from the radiation accident victim for radiological analysis and explain why they are needed.

9. Briefly describe procedures for the decontamination of wounds.

10. Demonstrate appropriate techniques for decontaminating the intact skin.

11. Explain why serious medical problems should have priority over concerns about exposure and contamination during the treatment of a radiaticn accident victim.

12. State the reason for carefully documenting information during the emergency care of a radiation accident victim and list categories of information that should be documented.

13. Discuss the notification and verification of contaminated-injured persons; communications and hospital public relation and information capability.

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THE HANDLING AND TREATMENT OF RADIOACTIVELY CONTAMINATED AND INJURED PATIENTS BY EMERGENCY. SERVICES PERSONNEL Review and Test (PLEASE CIRCLE APPROPRIATE ANSWERS)

1. The party responsible for preventing the spread of contamination at the accident site is:

a) Security b) Health Physicist c) ER Physician

2. Three principles which apply to protection from radiation are: TIME, DISTANCE, AND SHIELDING.

a) True b) False .

3. If possible, the Emergency Room should be prepared prior to admitting a radioactively contaminated patient.

a) True b) False

4. Decontamination should take priority over life-threatening conditions created by traumatic injury.

a) True b) False

5. In the event of.a radiation accident involving a plant worker, the individual who should issue a public statement is:

a) Attending Physician b) Hospital Public Relations Officer assisted, if necessary, by a trained local physician c) The head nurse of the emergency department

6. Did you find the lecture and/or demonstration of material informative?

a) ves b) No

7. Were slide presentations and handouts helpful in understanding the material?

a) Yes b) No

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8. San onofre personnel may be consulted for any information in the handling of a radioactively contaminated patient. '

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I a) True-b) False

9. What type of recommendation would you make for future presentations?

10. There is no difference between radiation exposure and j radioactive contamination of an individual. 3 a) True b) False ,.

Name: Date:

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I HANDLING AND TREATMENT OF RADICACTIVELY CONTAMINATED AND INJURED PATIENTS

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Review Information l j '. i i

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o TABLE OF CONTENTS Topic Page Role of Physicians, Nurses and Support 1 Personnel in Initial Management of Radiation Accidents Initial Emergency Room' Management of 7 Radiation Accident Patients Whole Body' Irradiation - Biological -

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Ef r.!ects A Collection of Helpful Items for Medical 19 Evaluation of Ionizing Radiation Exposure Cases

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ROLE OF PHYSICIANS, NURSES AND SUPPORT PERSONNEL IN INITIAL MANAGEMENT OF RADIATION ACCIDENTS l

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As with casualties from any accident, trained emergency room personnel are essential to the management of radiation accident victims. During an initial planning period, the Emergency Department head physician, nurse, supervisor or disaster-planning ~- l committee personnel may be asked to draft a procedure manual and assist with the training of other staff. Although specific emergency medical procedures may be routine, other aspects of '

radiation casualty care are unique. The presence of radioactive I contamination in the emergency room area requires measures to control its spread. Health physicists from the nuclear utility are available to assist the hospital personnel in radiation protection principles and practices. Further, the patient and family need explanations and reassurance as to potential effects of the radiation encountered.

Emergency room personnel can be most helpful if they have a basic understanding of radiation in terms of protective measures, detectability, and relative potential for causing injury.

Familiarity with procedural guidelines will enhance their effectiveness in patient management, ultimately contributing to the patient's well being.

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.I. EMERGENCY DEPARTMENT PREPAREDNESS' A. Responsibility of the ER staff physician, nurses, health physicists.

1. Emergency room' leader and support personnel.

2.. Response procedures for treating the injured - ]

contaminated patient.

3. Notification and verification of contaminated -' I injured to be. received by the hospital.

B. Education / Training of Emergency Room Medical Staff.

1. Emphasize basic information about radioactivity -

are they " comfortable" in the presence of radiation?

2. Periodic review of procedural guidelines; drills,.

in-service training, self-taught audiovisual programs..

C. Interdepartmental Cooperation.

1. Identify persons specifically responsible for participation in casualty management.

2. Hospital administrative procedures.

3. Department responsibilities.

4. Include all appropriate departments in periodic drills and review procedures.

D. In-House Procedure Manual for Radiation Accident Management.

1. References are available to help with establishing guidelines and detailed procedures.

2. Identify chain of command to be followed in accident situations; include responsibility for telephone contacts.

3. Describe job responsibilities in. sufficient detail to allow participation by new personnel.

4 .. Review and revise procedures after every drill (update telephone list frequently).

5. Keep manuals readily available to Emergency Room personnel.

478.txt 2

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E. Appropriate Facility for Decontamination procedures.

1. Ensure that area meets essential criteria:

proximity to emergency equipment, separate from other patient traffic, sufficient space for emergency treatment and decontaminations, etc.

2. Monitoring Equipment:

a. Identify location of survey meters, dosimeters.

b. Ensure periodic calibration of meters and replacement of dosimeters.

3. Plan to use Emergency Room equipment and supplies as much as possible. Special storage area should include only those items not readily available in Emergency Department (e.g., monitoring equipment, special signs and barrier tape, floor covering, protective clothing, . sampling ~ kits, etc.).

478.txt 3

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l II. STEPS IN THE MANAGEMENT OF RADIATION CASUALTIES A. Initial call - essential information. I

1. Type of accident - is contamination (internal or external) a possibility?

2. Number of casualties - is there a need to expand the treatment area?

3. Severity of injuries - is there a need to call in other personnel?

4. Radiation exposure levels around patient - might exposure of hospital staff be a concern? Have the -

radioisotopes been identified? SSKI may be dispensed if radiciodine is.present.

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5. Expected time of arrival - preparations take time,  ;

does ambulance know correct discharge area?  !

6. Name and telephone number of caller - it may be necessary to make a return call to accident site; communication possible with ambulance?

7. Accompanying personnel - health physics personnel from the accident site would be very helpful.

B. Preparation of Area, Supplies and Personnel.

1. Follow procedure manual guidelines.

2. Ensure that sufficient personnel are available and knowledgeable as to their responsibilities;.more than one patient may require second physician /

nurse team; a recorder is essential.

3. Make provision for sufficient coverage of other Emergency Room patients.

4. Alert other hospital services who might become involved (e.g., clinical laboratory, x-ray department, operating room).

5. Procure supplies and equipment from Emergency Room as potentially needed.

6. Are dosimeters properly dispensed? Is survey meter working correctly?

7. Brief personnel on what to expect.

L 478.txt 4

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C. patient Arrival and Management of Care.

1. Follow standard emergency medical / nursing procedures as much as possible; contamination is a nuisance, not a medical emergency; concern for staff exposure high unlikely.

2. Ascertain information concerning accident itself; consider precipitating medical causes and general medical history of patient.

3. Sampling is essential; pre-marked sampling supplies should ensure their use.

4. Focus on patient's emotional needs: .

a. Patient will be apprehensive, concerned about both medical and radiological injuries.

b. Negligence may be a factor; consider patient's feelings of guilt, concern for job security.

c. Explain need for special protective measures; patient may or may not be familiar with properties of radioactivity.

5. Consider family members present and their need for reassurance; radiation not " contagious" despite elaborate protective measures; serious overexposure may require long-term follow-up.  ;

6. Anticipate patient's transfer to other hospital '

area or home; ensure that follow-up hospital personnel or family understand that patient should no longer be source of radiation exposure (in an extreme emergency, patient could be taken directly ,

to operating room - similar protective measures would be initiated there).

D. Immediate Follow-Up Concerns.

]

l l 1. Are all samples correctly labeled and directed to

! appropriate labs or industrial site?

4

2. Is paper work complete?

4 J

3. Has area been restored to original use? Confirmed as free of contamination? I

4. Have accident site personnel been apprised of 1 patient's progress and disposition? I

5. Arrange a meeting of all participants to discuss management process, suggestions for greater efficiency, concerns of the staff vis-a-vis their own exposure.

478.txt 5 )

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e III. RELATED TOPICS FOR IN-SERVICE PROGRAMS A. Basic radiation; common sources of radiation, protective measures, relationship of dose to biological effects.

B. Radiation doses; environmental, medical, occupational (especially hospital employees), expected doses while caring for radiation casualty.

C. Measurement of radiation; use of dosimeters, survey meters, whole body counters, etc. (suggest they visit Nuclear Medicine Department for actual measurement of radioactivity); bioassays for internal contamination.

D. Mixed injuries; the contaminated burn, inhalation of contaminated smoke particles, determination of internal contamination, etc.

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N INITIAL EMERGENCY ROOM MANAGEMENT OF RADIATION ACCIDENT PATIENTS Management of the radiation accident casualty is in many ways no different from that of any accident victim coming to the Emergency Room. The person {

j who has been simply exposed to a radiation field like a-patient completing.  !

radiation therapy, presents no hazard to the attending medical care team, j The presence of radioactive contamination, as liquid or particulate material, does require appropriate care to avoid spread of the radioactivity to other areas of the hospital. In addition, all contaminated materials must be removed rapidly and efficiently to avoid internal contamination of the .

patient and to minimize radiation exposure to both victim and staff. Because ,

radiation cannot be appreciated by any of the human senses, reliable instru-mentation is needed to locate and identify radioactivity in the environment or on the patient.

I.

Specific Management Concerns According to Types of Radiation Casualties A. Whole body or extremity exposure - no special protective measures for staff or environment; no need for monitoring instrumen-tation B.

Internal contamination only - glove protection when handling excreta; body fluids saved and labeled as directed C. External contamination of clothing and/or body surface - special measures to limit spread of contamination; protective clothing for immediate staff; personnel and environmental ~

monitoring 4

II. Procedural Guidelines A. Required by the Joint Commission on Accreditation of Hospitals

8. Detailed as necessary will be infrequently utilized; 'some unfamiliar routines -

C. Include agreements with industry, updated communications network, physical specifications, specific procedures, equipment requirements and location, job responsibilities ,

D. Keep guidelines readily available for all participants E.

Prepare in advance for special needs:x-rays, scans, counting of samples III. Victim of Overexposure Only A.

No special precautions; can be observed and treated in general Emergency Room

8. Review of accident scenario with victim or accompanying personnel 1

may determine extent of overexposure and need for immediate treatment C.

Identify consultative resources; local physician (s); State Depart-  !

ment of Health or Occupational Safety; 24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> consultative service offered by the Radiation Emergency Assistance Center /

Training Site. Oak Ridge. TN (REAC/TS) 7

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D. Extremity exposure; emphasis on determining actual exposure; greatest need for treatment may be in future weeks- months IV. Management Goals for the Contaminated Casualty A. Protection of patient from further injury B. Containment of all contamination C. Documentation of type and location of radioactivity D. Minimal exposure of personnel V. Radiation Emergency Area - Suggested Treatment Facility for Externally Contaminated Victim A. Separate room or area for decontamination of victim

1. can be cordoned off and other patients moved to suitable area

2. direct access to outside if possible

3. adjacent to emergency equipment 4 washing capabilities present - hot and cold water

5. air circulation filtered or shutoff ,

B. Buffer zone proximal to decontamination room for additional supplie~s and personnel; dedicated unlisted outside telephone line if possible VI. Departmental Responsibilities and Personnel ,Requiremeni; A. Nursing service

1. oversees area preparations; responsible for logistical' and staffing requirements

2. communicates with accident site

3. provides nursing staff to assist with patient care

8. Medical service

1. identifies the physician-in-charge; may be contract Emergency Room physician, physician under agreement with specific industry, rotating staff physician, or otherwise desig-nated physician; specialty physicians on call

2. radiologist or nuclear medicine physician may supervise radiological aspects of patient management

[ Industrial health physicist may come to the Emergency Room with victim; will monitor patient and interpret exposure levels vis-a-vis patient and personnel; will be familiar with radioisotopes involved - utilize his expertise.]

3. technologists from radiology and nuclear medicine departments can assist with monitoring of patient and supplies if familiar with survey meters C. Housekeeping department - for area preparation and to help, under  ;

supervision, with general clean-up D. Security department - to guard ambulance and entrance to Radiation Emergency Area E. Administration - public relations liaison with media, other hospital personnel,and community VII. Steps in the Management of a Contaminated Radiation Casualty A. Notification of accident

1. number of victims and extent of exposure and injuries 8

._m. - - - = - - ' ^ ^ ' '~-'

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2. is contamination really present?

3, what isotopes are involved?

4 preliminary first-aid and decontamination performed at accident site 5 other personnel accompanying victim to hospital' 6 repetition of all information to confirm accuracy

8. Radiation emergency area preparation

1. cover floor of treatment area and pathway from outside entrance with Herculitd'or impermeable paper (precut to fit

2. cordon off area and buffer zone with barrier tape

3. check monitoring equipment and cover probes with thin plastic wrap; pass out dosimeters to participating staff

4. assemble all supplies - most to be kept in buffer zone

5. protective clothing and double gloves for primary staff C. Arrival of Victim

1. life-saving measures always take precedence -

2. assess victim in ambulance if REA is not prepared and if .

medical condition allows

3. transfer patient to decontamination tub or facsimile

4. detain ambulance personnel and equipment in restricted area until surveyed and cleared f.or return to duty

5. remove all outer clothing from victim (contains most of i radioisotope); save his personal dosimeters

6. monitor victim to determine location and intensity of radio-activity (survey periodically throughout.the procedure)

7. perform superficial treatment of serious injury C. Sampling - to document presence and nature of contamination; to ensure removal of radioisotopes

1. take samples before and af ter decontamination, especially open exposed areas

a. prelabel sample holders to facilitate process

b. wound, skin, mouth and other orifices as appropriate:

dampened cotton-tip applicators

c. necrotic tissue

d. urine and feces if internal contamination is. suspected

2. label specimens as radioactive and identify by body location

3. blood samples as directed E. Decontamination of victim

1. contaminated wounds, highest priority

a. irrigate with copious normal saline for 3 minutes; repeat irrigation if necessary

b. surgical debridement may be needed

c. save all tissue removed for analysis

d. cover decontaminated wound prior to washing other areas

2. contaminated skin

a. wash with soap and tepid water scrubbing gently with soft brush or gauze pads for 1-2 minutes

b. if still contaminated repeat washing

c. do not irritate or abrade skin

d. if residual contamination is noted after 2 or 3 washings, cover with thin plastic for further treatment with more specific agents, to be determined by consultation 9

7

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e.

decontamination to a level 2-5 X background is a ppropria te (Note : background may be increased because of contam-

3. inated articles in room) contaminated eyes a.

b. rinse with water in the direction of nose to temple sample and repeat (a) until sampling indicates no contamination 4

contaminated ear canals a.

irrigate gently with small amount of water, suctioning frequently

b. repeat until sampling indicates no contamination

5. contaminated nares or mouth

a. turn head to side if possible b.

rinse with

c. avoid watersmall goingamounts of water suctioning frequently into stomach d.

perform gastric lavage if necassary. monitoring and -

sampling contents

6. contaminated hair

a. shampoo for 2-3 minutes and rir.se thoroughly

b. survey and repeat washing if neesssary

c. may cut hair but do not shave F. Transfer of patient

1. cover pathway for clean stretcher 2.

personnel remove outer apron and gown a id 1 set of gloves (or change staff)

3. transfer patient' to clean stretcher 4

G. survey stretcher wheels just prior to exit from area Personnel and area clean-up 1.

2. personnel remove protective clothing in c rrect order survey personnel for possible contamination; wash hands or shower if necessary

3. collect personnel dosimeters for definitive readout

4. place contaminated materials in plastic bags and mark radioactive, monitor. and remove to storage area or back to accident site 5.

survey all room surfaces; wash down contaminated areas under careful supervision of knowledgeable personnel VIII. Integration A.

of Two Disciplines; Health Physics and Medicine Prior meetings of industry based health physics personnel and medical personnel will clarify focus of patient management for each group B.

HPs - comfortable with radiation; know exposure of staff can be minimal with protective measures; " don't hesitate to treat patient because of contamination"; may need directions vis-a-vis medical procedures C.

Nursing and medical personnel - apprehensive about radiation -

may inhibit aggressive treatment of acute needs; "we need to know it is safe for us to work near patient"; may need interpretation of instrument readings 10

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IX. Importance of Periodic Drills A. Educational benefits

1. hands-on experience

2. familiarity with handling radioisotopes (if shortlived isotope is used)

3. experience available to new staff B. Assurance of quality patient care - rarity of accident precludes staff familiarity with routine C. Follow-up critique

1. allows suggestions for improved procedures

2. fosters discussion of staff concerns regarding radiation

-exposure i

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Whole Body Irradiation 1

I. Biological Effects of Acute High Dose Whole Body Radiation

( Acute = Dose given over seconds - minutes )

( High Dose = > 10 RENs )

A. Asymptomatic ( <100 REMS)

1. 20' REMS

4. Lowest amount of radiation which has a biologi-cal effect that can be measured in the in-dividual.

b. Most sensitive technique for measuring radia-tion damage is cytogenetics.

i. Cytogenetics involves culturing the patient's lymphocytes and examining them for chromosomal abnormalities.

11. Certain kinds of chromosomal abnor-malities (e.g., dicentrics) are very characteristic of radiation induced ab-normalities.

iii. The predisposition of circulating lym-phocytes to develop chromosomal abnor-l-

malities should not be misconstrued as evidence for radiation inducing genetic abnormalities in man. Although it is likely that they do occur, radiation in-duced genetic abnormalities have not been detected in een even when large populations- (Hiroshima and Nagasaki survivors) have been carefully studied.

c.- Approximately the same dose one receives when undergoing .a diagnostic test such as a cardiac catheterization or other angiographic proce-dure. Note that these procedures involve only partial body irradiation.

d. Temporary decrease in sperm count may occur.

2. 50 RENs A fall in the circulating lymphocyte count may be seen especially if serial counts are obtained.

12

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Whole Body Irradiation I Page 2 I

B. Symptomatic -

Acute Radiation Syndromes - ( >100 RENs)

1. 100 REMS 1 l

50% of patients have anorexia,or nausea. ]

2. 150 RENs Redness of the conjunctiva,may appear. i 3.

200 REMS - Hematopoietic Syndrome begins.

a. Vomiting occurs in 50% of persons.

i. Onset of vomiting between 20 minutes and threa hours after the exposure. Earlier onset suggests higher dose.

11. Psychogenic vomiting in frightened, unex-posed people is uncommon but must be con-sidered.

iii. Lack of vomiting excludes life threaten-ing exposure. l

6. Decreased production of blood cells.

i. Rarely fatal at this dose.

11. Lowest blood counts occur )

after the exposure.

3-4 weeks i

c. Loss of hair.

i. Late effect - after 17 -20 days. i

3. 350 RENs Dose expected to kill 50% of untreated individuals.

If measures are taken to avoid infections and hemorrhage, the LD50 may be considerably higher.

4. 600 RENs

a. Bone marrow transplantation should be con-sidered.  !

i. Probable 50-80% fatality rate without transplant. i

11. Probability of finding a compatible donor t is cnly about 40%.

iii. Probability of a successful transplant given a compatible donor is 50-60XI total probability of success is .4 x . 5 or '

20%.

b.

c.

Permanent sterility (men and women) likely.

Death occurs 4-5 weeks after the accident.

13

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Whole Body Irradiation Page 3

5. 700 RENs - Gastrointestinal Syndrome

a. At this dose, the lining of the gastrointes-tinal tract is damaged. This creates several additional life threatening problems.

i. The normal secretary and absorptive func-tions of the GI tract are impaired resulting in an unstable fluid balance and poor nutrition. - -

li. The barrier between the bacteria normally' found in the G. 1. tract and the rest of >

the body is destroyedi further increasing the chances of infection,

b. Mortality is thought to . approach 100% but very little experience in humans was available prior to the Chernobyl accident,

c. Death occurs 2-4 weeks following the accident.

6. 1000 RENs

a. Probably invariably fatali however, optimistic ,

supportive treatment is appropriate since dosimetry estimates are likely to be sig- f nificantly in error plus uniform exposure is unlikely.

b. 1200 REMS of "whole body radiation" are routinely used to prepare cancer patients and i aplastic anemia patients for bone marrow transplantation. This high radiation dose dif-fers from an accident in that

i. it is carefully planned so that the bone marrow receives the bulk of the dose and t the G. I. tract is spared. l

11. it is given in multiple small doses.

l

7. >2000 RENs - Cerebrovascular Syndrome

a. Hopeless.

b. The blood vessels of the body are damaged and become leaky. Loss of intra-vascular volume causes uncontrollable hypotension.

c. Edema of all organs. Cerebral edema causes profound neurological symptoms and may by the i cause of death,

d. Death occurs in days.

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Whole Body Irradiation Page 4 II. Frequency of Whole Body Accidents (1945-1986)

.A.

Most Common Medically Significant Radiation Accident.

85 accidents worldwide.

20 accidents in US.

B. Accounts for Most Fatalities.

45 worldwide (including 30 at Chernobyl).

5 in the US. ,

Ill. Types of Whole Body Accidents A. Criticality Accidents

1. Early Los Alamos Accidents '1945-46

2. Oak Ridge 1958

3. Yugoslavia 1958 4 Mol, Belgium 1965

5. Argentina 1984

6. Chernobyl 1986 B. External Sources

1. Marshall Islands 1954 Fallout.

2. Los Angeles 1958

3. Pittsburg 1967 4 Oakridge 1971

5. Parsippany, NJ 1974

6. Rockaway, NJ 1976

7. California 1979 NOTE: See Appendix A on page 7.

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i Whole Body Irradiation page 5 IV Management of Acute Whole Body Exposures A. General Considerations.

1. Acute whole body radiation exposure is not a medi-cal emergency. Don't. allow the radiation exposure to distract you emergency. from caring for any'true medical be treated Possible internal contamination should expediously when indicated.'

contamination should be removed when the patient Externa'I.

stabilized. is

2. Reassure patient from the start.

a.

Clearly identifyneed This physician one not physician to be in charge.

be a radiation but expert should the patient.

be very sympathetic to the needs of' at all This physician should be present major discussions with the patient and should be willing to explain in detail what has happened and what is planned for the future.

He must be empowered to protect the patient' from unnecessary investigations and to_ protect the patient's privacy.

3. Because of the rarity of radiation accidents you will have more " help" than you could want after an hour or two.

Concentrate on the few things which you should do for this short time.

B. Specific Considerations

1. Estimate' probable dose.

a.

Serial be blood counts with a differential should obtained ~immediately and every 6 hours6.944444e-5 days <br />0.00167 hours <br />9.920635e-6 weeks <br />2.283e-6 months <br /> for the first 48 hours5.555556e-4 days <br />0.0133 hours <br />7.936508e-5 weeks <br />1.8264e-5 months <br />. These blood counts will be the most reliable prognostic indicator.

b. Cytogenetic. studies should be ordered but the i results may take weeks.

c. Data from the patient's radiation badge and-

d. from radiation monitors should be obtained.

If the radiation source include neutrons, the amount of exposure can be estimated by measur-ing residual radioactivity induced by the R neutrons. This amount of activity is small and does not represent a risk to medical personal.

Useful. samples are the blood, hair and finger-nails, metalic objects such as the rims of eyeglasses, jewelry, coins, wristwatches, but- I tons, etc.

objects should be therecorded, exact location of these metal

f. Obtain e patient description of'the 4ccident from the and .all eyewitnesses. Eventually a mock-up of t.Ne accident should be done to es-timate the dosametry.

Tnese estimates can be 16

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Whole Body Irradiation Page 6 grossly in error since they depend partly on the witnesses estimate of the time of exposure.

2. Low Dose ( < 25 RENs ). )

a. Reassurance.

Common questions involve risk of cancer , risk to future child and sterility, ,

i

b. Follow-up.

3. Very High Dose ( > 2000 RENs). -

Invariably fatal provide supportive care and emo-tional support.

4 Potentially Fatal Dose ( 100 RENs - 2000 REMS).

a. Initial dose estimate is quite approximate therefore patient should be given the benefit of the doubt.

b. Avoid ordinary hospital environment to prevent c.

colonization with resistant bacteria.

Ideally identify one matched donor for white cells and platelets.

d. Consider transfer to a facility expert in bone marrow transplants.

e. If granulocyte col nts fall below 1500, use laminar flow facility, prophylatic oral an-tibioticss routine cultures.

f. Treat fever with systemic entibiotics.

g. Weakness and fatigue may last several months.

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A COLLECTION OF HELPFUL !TEMS FOR MEDICAL EVALUATION OF IONIZING RADIATION EXPOSURE CASES I

t

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This collection of miscellany provides information designed to help physicians to evaluate and treat radiation cases. It is divided into tour sections: .

pages '

Sub.fects .

I. DIRECT 'JiOLE BODY RADIATION CASES 19

!!. LOCAL RADIATION BURNS 23

!!!. RAD 10ACT!YE INTERNAL CONTAMINATION 25 IV. LATE EFFECTS 30

1. DIRECT WHOLE 800Y RADIATION CASES History:

1. Circumstances of exposure.

2. Source: Type of radiation, source' strength, preliminary radiation measurements.

3. Position of patient relative to source.

4. Length of exposure.

5. Innediate symptoms (if any).

Initial Clinical Response (First 48 hours5.555556e-4 days <br />0.0133 hours <br />7.936508e-5 weeks <br />1.8264e-5 months <br />):

1. Early gastrointestinal symptomatology:

Possible Oose Range Anorexia Most sensitive symptom 2M rad or 30+R Nausea 754. ad or 110+R Vomiting 100+ rad or 150+R Otarrhea Ominous 150+ rad or 225+R (Ooses assume acute, one-time exposure; doses in reds are at body midline after whole body exposure)

~

1 19 s

r-a f ,

2. Lymphocyte absolute count (Fair Prognostic Value) 1500-3000 lymphs /nm 3 -

Nomal 1000-1500 -

Moderate injury; Good prognesis 500-1000

• l Severe injury: Fair prognosis 6 100- 500 -

Very severe injury; Poor prognosis  ;

Under 100 - Lethal I

3.

Chromosome analysis: study of chromosomes in peripheral lymphocytes is probably the most sensitive laboratory test for detecting changes due to ionizing radiation. The ,

number of chromosome aberrations', including inversions, translocations, deletions, dicentrics, and rings, can be used to estimate the exposure. The technique appears to be '

useful for evaluating exposures as low as about 10 rem to '

the whole body.

4. Skin erythema: can appear within minutes to hours following a single correlating with knlarge own exposureexposure. Positive suggests anresponse exposure in excess of several hundred rads, but is only a confimatory sign--not diagnostic. Skin response varies with dose fractionation, dose rate, radiation energy, depth-dose distribution, area size, anatomical region, and presence of other irritants,- nonionizing radiations (UV), or trauma.

Radiation Oose Tems:

pemissible dose "The permissibla. dose for an individual is that dose, accumulated over a long period of time or resulting from a single exposure, which, in the light of present knowledge, carries a negligible probability of severe somatic or genetic injuries; furtherisore, it is such a dose that any effects that ensue more frequently are Ilmited to those of a minor nature that would not be

• considered unacceptable by the exposed individual and by' competent medical authorities." (!CRP Publication 6, 1964). The permissible dose values are derived by independent professional bodies--National Council on Radiation Protection and Measurements (NCRP) and the International Commission on Radiological Protection (!CRP). ,

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• - U.S. Radia2 ion E*Dosure Limits For Workers in Radiation Areas (For Nuclear Regulatory Comission licensees; AU Code of Federal Regs. 20.101)

Rems / calendar Quarter

1. Whole body; head and trunk; active 1 1/j' blood-forming organs; lens of eyes; or gonads

2. Hands and forearms; feet and ankles 18 3/4 * -

3. Skin of whole body 7 1/2

• If previous occupational doses are known, the whole body exposure limit may be revised to 3 rems / quarter provided accumulated occupational dose does not exceed 5(N-18) where N equals the individual's age in years at his last birthday.

Emeroency Dose Limits - Life Saving Purposes (NCRP Report No. 39)

1. Individual (older than 45 years if 100 rems possible)

2. Hands and forearns -

200 rems, additional

, (300 rams total).

quality factor (OF) - arbitrary modifier used to trans-late rad to rem in radiation protection work to equate the probable biological effects resulting from differ-ent radiations; common values used are 1 for x- or gamma rays,1 for electrons 5 for protons,10 or 20 for alpha particles, and 10 or Iess for neutrons (varies markedly with neutron energies).

rad - most consnota dosimetry term; defined as 100 ergs per gram of absorbed energy in any material.

relative biological effectiveness (R8E) - correction factor that equates various biological effects (mortality, cataracts, etc.) from exposure to various ionizing radiations to that of standard 250 kev x-rays or soCo gasina rays.

rem - a dose equivalent unit that describes the same biological effectiveness as an absorbed dose of 1 rad x-radiation. (rea = rad x QF x other modifiers.)

roentgen (R) - special unit of exposure (air measure-ments) most consoonly used for x-ray a$ gama measure-ments. One roentgen produces 2.58x10 coulombs per kilogram of air. One roentgen exposure delivers about 93 ergs per gram of soft tissue.

21

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OOSE-EFFECT RELATIONSHIPS FOLLOWING ACUTE WHOLE 800Y IRRADI ATION (X- OR GAf94A) t

• Whole Body

• Clinical and Laboratory Oose (rad) Findings 5 - 25 Asymptomatic. Conventional blood studies are nomal . Chromosome aberrations detectable.

50 - 75 Asymptomatic. Minor depressions of white cells and platelets detectable in a few persons, especially if baseline values established. , ,

75 - 125 Minimal acute doses that produce prodromal symptoms (anorexia, nausea, vomiting, fatigue) in about 10-20% of persons within 2 days. Mild depressions of white cells and platelets in some persons. -

. 125 - 200 Symptomatic course with transient disability and clear hematological changes in a majority of exposed persons. Lymphocyte depression of about 50% within 48 hours5.555556e-4 days <br />0.0133 hours <br />7.936508e-5 weeks <br />1.8264e-5 months <br />.

240 - 340 Serious, disabling illness in most persons with about 50% mortality, if untreated. Lymphocyte depression of about 75+% within 48 hours5.555556e-4 days <br />0.0133 hours <br />7.936508e-5 weeks <br />1.8264e-5 months <br />.

500 + Accelerated version of acute radiation syndrome with gastrointestinal complications within two weeks, bleeding, and death in most exposed persons.

5000 + Fulminating course with cardiovascular, gastro-intestinal and CMS complications resulting in death within 24 72 hours8.333333e-4 days <br />0.02 hours <br />1.190476e-4 weeks <br />2.7396e-5 months <br />.

Conversion of rad (midline) dose to radiation measurements (

in R can be made roughly by multiplying rad times 1.5.

For exampt , 200 rad (midline) is equal to about 300 R '

(200 x 1.5 .

O e

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!!. LOCAL RADIATION BURNS History:

1. Exposure to radiation may not be recognized; suspician aust be high if painful burn-like symptoms present

- without known etiology.

2. Local burns usually result from handling a radioactive source or samples in or around x-ray apparatus or accelerator beams.

3. Development of burn symptoms is much slower than with themal burns. Blister formation within less than one week does not occur unless a severe radiation burn has been sustained. The shorter the latent period before symptoms, the more severe is the radiation burn. -

4. The energy of radiations (penetration power) is an important factor, expecially in beta-ray burns.

Representative Ooses to Produce Skin Effects:

300R Theshold erythema(1000 Threshold erythema (100 kev kevx-ray x-ray) ) 600-1000R Raw, moist area 1500R Ulceration, slow healing 2000+R Gangrene 3000+R Clinical Classification of Acute Radiation Burns:

Erythee_a: similar to first degree themal burn.

The erythema appears 2-3 weeks after exposure depending on the dose. At the time of exposure there may be no symptoms of a burn.

Transeoidemal Injury: similar to second degree them41 burn with a latent period of 1-2 weeks before blister femation depending on the dose. Initial symptoms at the burn site are erythema, pain, swelling, and itching j

> cr tingling. Usually will heal without skin grafting

- if protected to prevent infections.

Full-thickness Radiation Burn: similar to third degree themel burn and 15 a more serious version of transepidemal injury. Injury extends into the demis and produces prompt, intense pain. If involved area is more than a couple of centimeters in extent, skin grafting will be likely. Larger areas may involve necrosis and gangrene of the distal portion of the fingers or extremities and require amputation. Damage f to the circulation is of prime importance in ultimate l healing.

23

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Treatment Considerations:

1. Evaluate the possibilities of direct whole body (acute radiation syndrome) exposure.

(SeeSectionI.) i i

2. In beta-ray burns, early excision and skin grafting '

will spare the patient much discomfort and permit early restoration of function. In more penetrating exposunes .

(x- or gamma), the extent of the burn and condition of evaluate early. circulation will be more difficult to subcutaneous 3 i

3. Sterile, protective dressings should be used on local )

burns. No particular type of local ointment appears to be advantageous in treatment.

4. Surgical treatment should be minimized if in the early I l

weeks of hematopoietic changes (depression) are noted ,

or anticipated due to radiation exposure.

e 24

1

- t I III.

RADIOACTIVE INTERNAL CONTAMINATION Radioactively contaminated materials may result in external body. The fol surface (skin) lowing lists may be useful in emergencyc planning.

On-site Emeroency Check list '

(Note: The sequence and priority of these actions will vary with different accident condit1ons )

provide emergency medical care inmediately for serious injuries and preserve vital functions. Minor injuries can ,

wait until after initial radiation survey has been completed. l Remove individual from contaminated radiation area.

Individual doses up to 100 rems may be permitted for life saving purposes or up to 25 rems for less urgent needs (NCRP Report No. 39). Teams may be.used in relays to remove injured persons from very high radiation areas.

Survey individual for surface contamination levels.

Get nasal smears. Do this before showering.

Remove contaminated clothes and replace with clean coveralls or wrap in blanket. Take subject to an area where skin decontamination or showering can be done, i

Decontaminate skin. Remove all transferable contamination by citansing. contaminated skin areas and showering. .

Cover contaminated wounds with sterile dressings before and after decontamination efforts.

Alert hospital and call for as6ulance service as soon as it is determined that it is needed. Apprise them of the situation if their help is required.

Identify what radionuclide(s) is(are) involved in the accident and, if possible, ascertain its chemical form, solubility, and presumed particle size.

Send personnel radiation dosimeters for processing.

Get complete history of accident, especially as it relates to the activities of the patient. Where was he? What was he doing? Exit path 7 Symptoms?

Evaluate possibility of penetrating radiation exposure.

25

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a i

Advise patient on collection of all excreta. Provide containers. Save other contaminated materials.

j 8e sure someone has assumed responsibility for management l of the accident area. Is radiological assistance needed?  !

Who will request it? From whom? l l

Report your initial responses and evaluation to the plan't

, manager.

Get names of ' supervisory and health physics personnel who will remain on call in case additional information is needed.

Take subject to the hospital if injuries require surgical care not available at plant or if further medical or ,

dosimetric evaluation and treatment is required. .

Take precautions to prevent spread of contamination during transport and movement of the patient. Have transport vehicles, attendants, and equipment checked for residual radioactive contamination before release from hospital area.

If environmental contamination outside the plant has occurred, notify public health authorities.

Advise family and next of kin on the extent of injuries and exposure. Plant management, personnel and the medical department should agree on the proper procedure.

Find out where to send bicassay specimens and length of time required for analysis. Specify who will receive the results.

Reference:

NCRP, 1980.. " Management of Persons Accidentally Contaminated With Radionuclides", NCRP Report No. 65 (National Council on Radiation Protection and Measurements.

Washington).

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Planning Considerations for Hospital Management of the Radioactively-Contaminated Patient A. Planning Considerations.

' Assemble hospital team of staff persons trained to mana9e contaminated radiation cases, including physicians, medical

- physicists, technicians, and nurses. A team leader shall be designated. Develop a list of consultants for advice such as physicians and health physicists experienced in ,

handling such problems. These persons will aid the physician in charge of the case, as requested, in perfoming decontamination procedures.

Use preselected area in hospital that is suita'ble for decontamination of patients - consider location of room in ,

an area of the hospital having a nearby outside entry, showers, hot and cold water, floor drains, ease of room washdown, table suitable for washdown, and isolation of air movement thru air conditioning or heating system. Consider physiotherapy mom, cast room, regular emergency room autopsy room as possible candidates unless a special , or

, decontamination room is available.

Plan to evaluate the patient's medical condition imedi-ately so as to determine priority of need for medical or surgical treatment, important diagnostic procedures, and decontamination procedures.

plan to move patient within the hospital as little as possible so as to minimize hospital contamination. Keep patient in selected work area for medical and minor surgical treatment until loose contamination has been removed.

Arrange to have a health physicist monitor area entrances and hallways after the patient is located in the room so as to prevent " tracking" to other hospital areas.

• Se prepared to set up monitoring station (s) at exits from the work area. Personnel should not leave the room (area) unless monitored for radioactivity. Equipment or property should not be removed from the room unless monitored.

Designate persons to perform these monitoring tasks at specific locations. -

Prepare a list of decontamination room supolies (see list on page 13) and either store them in the r5am or identify where they are available for quick assembly.

27

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i B. Hospital Decontamination procedures Personnel and gowns should wear surgical scrub suits, surgical caps industriaIdependinguponduties).and rubber gloves (surgical, ho

' The team leader should be trained to recognize the rare,. ,

instance when there may be a need for masks, respirators, or supplied airpacks due to the presence of very high levels of alpha or beta radionuclides.

Rubber or plastic shoe covers are desirable. Those performing the actual decontamination with water should wear plastic or rubber laboratory aprons. Good temporary shee covers for dry areas can be improvised from' brown paper bags held on with adhesive or masking tape. '

Air conditioning and forced air heating systems should be turned off so radioactive particulates are not carried into ducts or to other rooms unless a special filtered system has been designed for use under these conditions.

The floors should be protected with a disposable covering to reduce " tracking" by keeping cleaner surfaces and to aid t5e clean up tasks. The covering should be changed when significant contamination is present. Brown paper rolls (36 inches wide, 60-pound weight) are ideal where water is not used. Plastic sheets are useful where spillage of liquids is a problem, although ribbed or nonskid types should be used tn t educe the chance of slips and falls.

All contaminated clothing should be placed carefully into plastic or paper bags to reduce secondary contamination of area.

Splashing of talutien used in decontamination should be avoided.

FStients nd personnel may move to clean areas only after

. surveys show satisfactory decontamination.

All passage of persons and property between contaminated and clean areas must be surveyed and regulated by monitoring teams.

1 l

28

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Supplies are passed through monitoring stations from clean areas to contaminated areas. Reverse flow must not occur

. unless monitored and found clean.

All individuals on the decontamination team shall be trained in radiological monitoring and decontamination techniques. Persons not working on the team should be excluded from the work area. '

Fiberboard or steel drums with tight fitting tops should be obtained for contaminated materials. Labels describing the contents should be affixed so that proper disposal can be carried out without reopening them. They may be sealed with masking tape or some other type of sealing tape. i Personal dosimeters (pocket chambers, film badge or TLD dosimeters) should be supplied to all personnel working in .

the decontamination area. Personnel should be rotated after a dose of 5 runs (or less if possible) is received.

The entry of all nonessential personnel including family, visitors, and administrative persons should be restricted. I

Reference:

NCRP,1980. ' Management of Persons Accidentally Contaminated With Radionuclides", NCRP Report No. 65 (National f Council on Radiation Protection and Measurements, Washington).

9 9

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4 i

IV. LATE EFFECTS OF IONIZING RADIATION $

The potential late or delayed effects of after accidental radiation exposures are: greatest interest

1. Chronic Radiodermatitis. , ,

Dry, atrophic, hairless skin with numerous telangiec-tatic areas is more prone to develop squamous-call or basal-cell carcinomas. Doses required to produce late skin sequelae are likely to be in excess of 1000 rads to the basal cell area. If dose is protracted over periods greater than 30 days, it is probable that chronic sequelae can occur without producing an acute skin reaction or developing chronic radioderinatitis.

2. Cataracts. .

Direct exposure of the lens to x- or gamma rays, neutrons, and even higher energy beta rays can produce cataracts. Requires single dose of the order of 600 rads (200 rad minimum) of x- or gamma rays or 70 rad of fast neutrons. Protracted doses require higher exposure totals before effects may he noted. A latent period of several months to many years is present before beginning opacities are noted in the posterior subcapsular area of the lens.

No features are pathognomonic, although initial changes at the posterior pole are expected. Radiation cataracts do not progress necessarily to complete loss of sight.

, 3. Sterility.

termanent sterility has not been noted following accidental whole body exposures even after exposure to the i sid-lethal dose range of 300 rad. Doses of 500-600 can

- produce permanent start 11ty, while in males doses as low as 50 rads can cause a temporary period of startlity.

Radiation does not appear to have significant effects on potency or libido. -

4. Pre-natal Radiation Effects.

The fetus is particularly sensitive to radiation exposure during the period of major organogenesis (second to sixth week of gestation in man). Teratogenic effects are believed possible to low doses (10 rads) in man. For this reason, the NCRP has reconnended that the maximum permissible dose equivalent to the fetus from occupational exposure of the expectant mother should not exceed 0.5 rem during the eistire gestation period (NCRP 1977).

30

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c. ,

5. Carcinogenesis.

Development of cancer is the major late health effect resulting from exposure to ionizing radiation.

Epidemiologic studies in man estimate a lifetime risk of excess cancer mortality per million persons per rad exposure of 75 to 250 cases (most likely value is about 100 to 125). Age at exposure to ionizin

- factor in the carcinogenic response.g Forradiation exampleis afor majof '

leukemia the risk increases with age of exposure a,fter about 15 to 20 years of age; for breast cancer in women, the greatest sensitivity occurs during teenage. The table below shows the major radiation-induced cancers shown to have higher relative sensitivity to radiation and the a estimated risk. The risk estiwates, taken from several authoritative sources, are nevertheless tentative and approximate. The question as to whether a threshold dose '

exists below which carcinogenesis is not induced is still not answered and probably never will be because one cannot detect these low probability excess cases statistically from among the higher baseline incidence of cancer from other causes.

The models from which risk estimates are extrapolated to the low dose regions are most frequently based on a linear, nonthreshold relationship. The data on which these estimates are based are nearly always from high dose exposures delivered at high dose rates ' The UNSCEAR Comittee problem as(UNSCEAR fol)ows: 1977) report calls attention to this "It is to be expected that low-LET radiation is likely to be less carcinogenic per unit absorbed dose at doses of a few rads than at levels of one or a few hundred rads. .... The value appropriate to the much lower dose levels involved in occupational exposure, and even more so in environmental exposures to radiation, may well be substantially less."

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31 -

1

f' Risk Estimates for Major Radiation-Induced Cancers Minimum Lifegime Excess Latent in 10 Persons / Rad Period Dependent Factors CancerZme, e Major Studies Fatal Cases incidence (Years) Age & Dose All Cancers 75 250 Leukemia

• Atom bomb survivors 15-60 15-60 2 x x Pelvic radiotherapy Spinal Scalp frradiation Thyroid Head / Chest ' radiotherapy 5-15 20-150 10 7 x Scalp irradiation Marshall Islanders Atom bomb survivors Breast Multiple fluoroscopies 10-80 30-200 <10 x x x Breast radiotherapy Atom %st survivors Lung ** Atom bomb survivors 20-90 20-100 10 x Uranius miners Spinal radiotherapy Alimentary Atom bomb survivors 10-15 15-35 10 x Canal Pelvic radiotherapy Spinal radiotherapy

'All forms except . chronic lymphocytic leukemia, which is not radiation induced.

• • History of cigarette smoking is an important dependent variable in the incidence of lung cancer.

i

Reference:

Selected data from UNSCEAR 1977; NAS/NRC' 1980; Pochin 1978.

e 32

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6. t.ife shortening.

Shortened life span without specific disease patterns has been studied by whole body irradiation of various animal species. This effect has not been demonstrated to date in either the Japanese atom bomb survivors or the Marshallese Islanders subjected to fallout irradiation. It has been noted in early American radiologists as a higher , .

age-specific death rate than in other medical specialists without occupational radiation exposure. This difference has lessened in recent years ap decreasing radiation exposures.parently as a Council The National result ofon Radiation Protection and Measurements (NCRP, 1971) states that " life shortening of persons whose exposure is '

maintained within presently recommended occupational limits f would be too small to detect in the presence of so'aany other variables. While it is probable that some small degree of life shortening from radiation in man may occur following high-dose exposure, its quantitative expression is not possible at the present time."

7. Genetic Effects The largest study on genetic effects of exposed humans has been done on the offspring of the Japanese atos bomb survivors. No genetic injury has been identified in these studies. These data has been interpreted to suggest that

- the dose required to double the mutation rate in Hiroshima and Nagasaki must be at least 150 res.

The UNSCEAR Comnittee report (UNSCEAR 1977), after reviewing experimental animal data and human data, uses a doubling dose value of 100 ram. The BEIR !!! Committee report (NAS/NRC 1980) indicates a range for the doubling dose of 50 to 250 res. The doubling dose is the amount of radiation exposure required to produce as many more mutations as are already occurring spontaneously.

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THE HANDLING AND TREATMENT OF RADIOACTIVELY CONTAMINATED AND INJURED PATIENT (S)

BY EMERGENCY DEPARTMENT PHYSICIANS AND NURSES Prepared for SCUDDERS AMBULANCE SERVICE and SAN CLEMENTE PARAMEDIC UNITS Prepared by Nuclear Affairs and Emergency Planning and Mesa Medical Department San Onofre Nuclear Generating Station SOUTHERN CALIFORNIA EDISON COMPANY P.O. Box 4198 San Clemente, California 92672 JUNE 4, 1987 1:30 p.m. - 3:30 p.m.

EX. 17

. i ,

RADIATION ACCIDENTS

__ EMERGENCY CARE OF THE INJURED AND CONTAMINATED PATIENT

= DISCOVERY

1. Check vital signs.

2. Notify Control Room.

3. Observe patient.

= RESCUE

1. Bring First Aid bag, stretcher, blaiikets and high dose rate meter.

2. Check for high radiation field.

3. Perform first aid.

4. Traffic Control.

.7 5. Check for other injuries.

6. Remove patient.

=TRANSPQRT

1. Blankets under and in stretcher.

2. Secure pallent in siretcher.  !

3. Take to ambulance pick-up point.

4. Continually check vital signs.

l

= EVACUATION

1. Provide ambulance with floor covering, dosimetry, and Anti-C clothing.

2. Direct ambulance to pick-up point.

3. Perform gross decontamination.

4. Transfer to ambulance stretcher.

5. Acconpany patient to hospital. *

6. Provide dose / hazard assessment.

=ON-SITE T R E A T M E N T (O P T I O N A L)

1. Stabilize injuries.

2. Leave wound dressing intact.  ;

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3. Decontamination. '

- Remove clothing.

j - Sanple 1

- Survey

- Scrub ]

4. Dose Assessment. l'

5. Evacuate to hospital.

I 1

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THE HANDLING AND TREATMENT OF RADIOACTIVELY CONTAMINATED AND INJURED PATIENT (S)

BY EMERGENCY SERVICES PERSONNEL Information Handout CONTENTS PAGE Radioactivity

. What, and where is it? 1

. Terminology 1 Radiation Accidents 5 Exposure Injury .

6 External Contamination Response 7 RescueLOperation Hazards 8 Rescue Personnel Exposure Guidelines 9 Dose-Effect Relationships 10 Skin Effects 11 Effect of Time on Radiation Exposure 12 Effect of Distance on Radiation Exposure 13 Effect of Shielding on Radiation Exposure 14

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RADIATION ACCIDENTS

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EXPOSURE '

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EXPOSURE INJURY Seldom Life-Threatening to Patient I

TraumaticInjury takes Precedence {

Clinical Course Unfolds Over Time Few initial Symptons l Must deal with Patient's Anxiety f)

No Hazard to Attendants Normal ER Procedures 1

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F S N O D E O S R R I NE A U T OID Z A A S N I

T L H OI P M AC RU N X A LON E T APO O N NRI I

T Y O D A D C RO R O EC A R E B T N P N NII L I O A SK -

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EXTERNAL CONTAMINATION

RESPONSE

TRAUMATIC INJURY ANXIETY DECONTAMINATION CONTAINMENT s

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EXPOSURE GUIDELINES SOOO mr Routine Assistance i 25000 mr Emergency Care 100000 mr Life-Saving Situation G

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f Dose-Effect Relationships 5,000 MREM NO OBSERVABLE EFFECTS 50,000 MREM BLOOD IHRESHHOLD 100,000 MREM SYMPTOM THRESHHOLD 350,000 MREM 50% LETHALITY 600,000 MREM APPROACHING 100% LETHALITY THESE RELATIONSHIPS FOR MIDLINE DEPTH DOSES OF THE TOTAL BODY ARE USEFUL IN THE INITIAL EVALUATION OF A PATIENT.

THESE EXPOSURES ARE FOR PENETRATING GAMMA OR X-RAY RADIATION THAT OCCURS l

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