ML20244D734

Applicant Rebuttal Testimony 24 (Training of MS-1 Hosp Responders).* Addresses Exercise Contention Mag EX-14,Basis C Re Adequacy of Training Provided to MS-1 Hosp Staff Responders.Related Correspondence

ML20244D734
Person / Time
Site:	Seabrook
Issue date:	04/18/1989
From:	Callendrello A, Ellis S, Frank C, Grew T ABB IMPELL CORP. (FORMERLY IMPELL CORP.), PUBLIC SERVICE CO. OF NEW HAMPSHIRE
To:
Shared Package
ML20244D592	List: ML20244D589 ML20244D605 ML20244D617 ML20244D632 ML20244D644 ML20244D657 ML20244D666 ML20244D669 ML20244D678 ML20244D706 ML20244D734
References
OL, NUDOCS 8904240091
Download: ML20244D734 (26)

Text

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$AATED CORRESPONM c:rC:

USNFC ,

'89 APR 20 PS :25 April 18, 1989 0FFIP.Or ._tbn* s 00CKE T % 1 :i4 if.f.

BPANCH UNITED STATES OF AMERICA NUCLEAR REGULATORY COMMISSION before the ATOMIC SAFETY AND LICENSING BOARD

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In the Matter of -)

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PUBLIC SERVICE COMPANY OF ) Docket Nos. 50-443-OL NEW HAMPSHIRE, et al. ) 50-444-OL

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(Seabrook Station, Units 1 and 2) ) (Off-site Emergency

) Planning Issues)

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APPLICANTS' REBUTTAL TESTIMONY NO. 24 (TRAINING OF MS-1 HOSPITAL RESPONDERS)

Panel Members: Anthony M. Callendrello, Manager, Emergency Preparedness-Licensing, New Hampshire Yankee-S. Joseph Ellis, Manager, Response and

-Implementation, New Hampshire Yankee Catherine M. Frank, Emergency Planner, Impell Corporation Thomas F. Grew, Specialty Training Manager, New Hampshire Yankee

,1 8904240091 PDR ADOCK h 4M PDR 43 T

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1 TABLE OF CONTENTS .

I. INTRODUCTION . . . . . . . . . . . . . . . . . . . . 1  :

II. EXERCISE PERFORMANCE AND FEMA EVALUATION 1 1

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Attachment.A: ' New Hampshire Radiological Health Program, Module 23A, Hospital Management of

. Contaminated and Injured Patients s

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I. INTRODUCTION l

This testimony addresses Exercise Contention MAG EX-14 Basis C, which challenges the adequacy of training provided  ;

to MS-l' hospital staff responders. Specifically, this contention alleges that, because additional training in the biological effects of radiation is required for'the staff, the ability of the hospital to handle and treat contaminated individuals is at issue.

II. EXERCISE PERFORMANCE AND FEMA EVALUATION Objective #24 of the 1988 FEMA Graded Exercise required the Offsite Response Organization (ORO) to "[d]emonstrate the adequacy of medical facilities equipment, procedures and personnel for handling contaminated, injured or exposed individuals". FEMA found that "[t]he New Hampshire Yankee Offsite Response Organization demonstrated that arrangements have been made to provide adequate medical fac'.lities, equipment, procedures, and personnel . . . [and] successfully demonstrated the adequacy of medical facilities, equipment, procedures, and personnel for handling contaminated, injured or exposed individuals". FEMA Exercise Report, Applicants' Exhibit 43F, at 238 of 428. FEMA specifically stated *

" Monitoring was performed by the Nuclear Medicine Department Radiation Safety Officer and nurses trained to make radiation and contamination ,

measurements . . . . Auxiliary staff personnel were well trained in preparing the area for receipt ]

of the potentially contaminated patient. The area was quickly prepared in an efficient and timely manner . . . . Supplies and equipment specific to

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handling a patient contaminated with radioactive-material were maintained as.specified and were immediately available when needed." Exercise Report at 239 of 428.

As defined in FEMA Information and Guidance Memorandum RI-TH-18-88 at page 3, Areas Requiring Corrective Action (ARCAs) "are demonstrated and observed inadequacies ofLState and local government (or utility offsite response organization) performance, and, although their corrective l action is required during the next scheduled biennial exercise, they are not considered, by themselves, to adversely impact public health and. safety". .The'ARCA i identified by FEMA'as a contamination controlfissue (Exercise Report, Applicants' Exhibit 43F at 239 and 274 of 428)-

requires correction before the next graded exercise. As described by FEMA, " Medical and nursing staff members did not fully understand the biological effects of radiation and the significance of counts per minute, contamination, and millirem per hour dose rate". As the Exercise Controller Logs and the Significant Events Log (Exercise Report, Applicants' Exhibit 43F, at 80-81 of 428) indicate, the ARCA does not involve the ability of the hospital to properly treat contaminated, injured individuals. Instead, the ARCA calls for more detailed training in radiological terminology and equipment readings, so that hospital staff may properly understand the significance, in terms of their own exposure,

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I of equipment readings for patients. The depth of' knowledge exhibited by the hospital staff did'not affect their demonstrated performance.

Initial training was conducted for MS-1 hospital staff on 4/27, 4/28, 5/19, and 6/23/88. The training module.used is Attachment A hereto. New Hampshire Yankee (NHY) has f committed.to providing additional training on the biological effects of radiat' ion for MS-1 hospital responders prior to the 1989 Medical Drill. Exercise Report at 292 of 428. ' FEMA l

found NHY's proposed ARCA resolutions and intended completion schedules "to be' adequate and--timely". See Attachment-J of Applicants'-Rebuttal Testimony No. 20 (ORO Prerequisites and Training).

To ensure adequate resolution of this training issue, NHY is currently in the process of arranging for the attendance of St. Joseph's hospital staff at training to be conducted by'Brigham and Women's Hospital on June 9, 1989.

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ATTACHMENT A (New Hampshire Radiological Health Program Module 23A {

Hospital Management Of Contaminated and Injured Patients) -l 1

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L.:. Attachment A (Paga'1 of.20)

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'dritten By: Procecure No, d j

Reviewea Ey: Revision No, 1

Approvec By: Issue Date:

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l NEW RAMPSHIRE EADIOLCGICAL HEALTH PROCRAM MODULE 23A HOSPITAL MANAGEMENT OF CONTAMINATED AND INJURED PATIENTS

-SEABROOK STATION '!

FEBRUARY 1988 i

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-Attachmant A'(Pago'2 ofJ20):. ~j f

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. TRAINING REQUIREMENTS o

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- Key hospital personnel will require the following training:

Training Module 20A - Hospital Management of Contaminated and Injured Patients

' 1pon. completion of the acove mocule hospital personnel will participate in an annual' refresher which will consist of a review of procedures including any enanges made since the last exercise.

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( COURSE SCOPE AND OBJECTIVES 1

SCOPE.

This training module provides instruction for key hospitsi personnel in the

l. management of. trauma and radioactive contamination. Topics include medical priorities, contamination control. personal protection and survey techniques.

The E ergency Classification Levels (ECL) will also be taught.

C BJ E CT ".*~ S At the conclusion of this progran, the participant should.be able to do the l follcwing:

. Exclain the difference between exposure and contamination with regard to rac:atien anc racicactive ester:als.

C. Jnderstanc wny basic lif e support measure have priority over contamination control :easures.

3. F.ecite to basic equipment needed for personal protection fres radioactive c onta:ninati on.

4. . Emergency Department personnel should be able to act on vital information from Ambulance Personnel with regard to patient status and degree of contamination..

5. Emergenc'/ Departments snould understand basic principles of contamination control for personnel and environment and be able to explain the rationale for sample taking and labeling.

6. Turn on survey meters check batteries, check background, and do a survey for contamination.

7. Explain the Emergency Classification Levels (ECL) system.

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-.- - 1 Attachmtnt A (Paga 4 of 20) '

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GENERAL COURSE INFORMATION i

l COURSE ~*TLE: Hospital Management of Contaminated and Injurec i

1 AUDIENCE: Hospital Personnel DURATTCN: 1.5 Hours SCOPE: This training module provides instruction for key hospital personnel in the canagement of trauma and radioactive con- j tamination. Topics include medical priorities. contamination: e control. ;ersonal protect 1:n and survey techniques. 7he-Emergency Classification Levels (ECL) system w111 also be taught.

Empnasis in eacn section will vary depending on staff background anc role in facility RERP.  ;

MATERIAL 5; Screen Slides Projector and Spare Bulb q

Videotape 3 VCR and Monitor Screen i Survey Meter Dosimetry Kit Attendance Form Participant Handouts I

REFERENCEE: 1. SUREG C654/ FEMA -REP-1. Rev. 1

2. ' Title 10. Code of Federal Regulations. Part 50.47(b)(12)

3. FEMA Guidance Memorandua MS-1

4. JointCommitteeobtheAccreditationofHospitals.

Emergency Services ER5.1.2.20 1987

5. NCRP Report No. 65. Management of Persons Contaminated with Radionuclides -

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6. Department of Health and Human Services. Food and Drug Administration 83-8211 Preparedness and Response in Radiation Accidents. August 1983

7. Medical Health Physics. Fourteenth Mid-Year Topical Synposium, 1980

8. Hafen and Karren. Prehospital Emergency Care and Crisis Intervention. 1983

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Attachmnnt A-(Paga 5 of 20)

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COURSE C'JTLItiE Management of Ccataminated and Injured Patients - Hospital Personnel '

Section'- Toolcs Time

.I. Introducti:n 2 lnin.

II. Basic Concepts and Definitions 15 min.

III. ' Concepts of Exposure and Contamination "

, 10 min.

V. Radiation Cetection and Instrumentation 5 min.

Y Protecti'le Clothing 2 min.

VI. Priorities in Trauma Management and 5 min.

Contamination Control VII.. Preparing an Ambulance for Accepting 2 min.

a Contaminated Injured Patient VIII. Trauma Management. Decontamination &

Sample Taking 15 min.

IX. Management of Severe Exposures 5 min.

X. Emergency Classification Levels 5 min.

XI. Video Tape - Hospith1 Emergency 25 min.

Department Response to Radiation Accidents l

XII. Suasary 10 min.

XIII. Questions and Course Ev luation s

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AttachmInc,A (Pagn 6 of.20) l INSTRUCTORS CUIDE Module Numoer: 23A Course

Title:

Hospital Management of Contaminated and: Injured Patients Lecture :l Time Slide l I. ' Introduction ," 2 min. Title Slide.

q A. The purpose of this program is to instruct Regulations you how to manage contaminated and injured patients. The program 13 designeo to eet the standarcs of:

1. SUREG-C654/ FEMA-REP-1 Planning Standard:

2. 10CFR50.47 (b)(12); f

3. FEMA Guidance Memorandum MS-1; and

4. JCAH Standards for Emergency Services ER.5.1.2.20 B. The three main areas of concern we will be Priorities talking about include management of the patient. protection of the staff, and protec-tion of the environment.  !

lI. Basic Definitions and Terms in Radiological 15 min.

Physics We neeo to discuss some basic terms and defini- Radiation tions to clearly identify what radiation and radioactive materials are and how they behave.

I A. The electromagnetic spectrum includes all EM Spectrum  !

radiation which is without mass or particulate -j nature and moves at the speeo of fight. This includes electric power at the low:end through radio waves: visible light; infra (ed: and ultraviolet, to ionizing x-rays. ganna rays.

and cosmic' rays from outer space at the high end. The energy of the rays at the upper end l

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i a Attachmsnt A (Pag $'7of20) l Lecture Time j Slide _

of the scale f rom x-rays to cosmic rays is high enough to cause ionization of atoms causing disruption of chemical bonds which results in damage.

S. For our purposes, we will be talking about Atomic Structure radiation that comes from atoms which are radioactive. This picture of an atom is not .

radioactive: we call it stable because it does not give off any excess energy. The parts of .

l i an atom include a very cense nucleus of .

f neutrons and protons. Neutrons have no charge i and protons have a positive charge of +1. -l Electrons, wnich have a negative :harge of -1 and I.;rmally balance off the positive charge of the nucleus. ;roit arounc the nucleus. The electrons have a mass only about 1/1800 of a nucleon so they do not take up much space in their orbits around the nucleus. f C. A radioactive atom has a surplus or defi-Radioactive Ator ciency of one of the nucleons and this results in an unstable configuration. This leads to a number of different ways the atom can transform to become stable and thereby release energy in the form of radiation.

There are many types of radiation that can ce emitted and more than ona type can be emitted from the same atom.

) . Let us look at tha types cf radiation we will Alpha Radiation be concerned with in the most likely types of radiological emergencies.

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1. Alpha radiation is 2 protons and 2 '

neutrons with a +2 charge. It is actually a Helium atom stripped of its electrons.

Comparatively speaking, in the atomic I world it is very large and heavy and does not go very far even in air. Il carries a -

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lot of energy and can do a lot of internal damage to live tissue: it will .:st. hawever.

penetrate the dead skin layer outside of our bodies, i I

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Attachment A (Page 8 of 20) \

l Lecture Time 11[ge

2. Beta raciatier. is an electron with a negative charge called a beta particle Beta Radiation or a positive charge called a positron.

It can be emitted directly from the nucleus or. under certain conditions, possibly from the croits. It can travel a few feet in air anc penetrate the skin but is depencent upon the amount of '

energy available. .

3. Gamma raciation is the high energy , Gamma Radiation electro:agnetic raciation we spoke of earlier. It is e:ltted from the nucleus and so=etimes accompanies alpha and beta radiations. :t is more cangerous than the other types because it is so penetrating. Remecoer, atoms are :ostly empty space and gir. a radiation has no mass er charge so it trave 2s a long way before it interacts. Gamma radiation is a threat both internally and externally.

X-rays are physically exactly like gamma X-Rays rays except that they are usually of lower energy. The energy spectrums overlap. The difference in physics is where they originate: gamma rays originate in the nucleus anc x-rays originate in the oroital shells of the electrons.

. The term used to descr:be how many radioac- Curie tive atoms we have is called a curie. This tells us how many radioactive atoms are disin-tegrating each second or .uinute, or how many unstable atoms are releasing radiation and ~

going to a stable state.

F. A Roentgen tells us how much radiation is Roentgen passing through a given volume or gpace of air. We are actually measuring hod much ionization is being produced. Thir can be measured with a survey meter.

G. A Rad (Radiation Absorced Dose) is how much Rad energy is being absorced in a given medium.

As the radiation bumps into molecules, it causes ionizations and dissipates its energy along a path through the material.

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Attachment A (Page 9 of 20) 4 Lecture Time Slide H. A Rem relates the amount cf energy in Rads Rem being deposited in living t!: sue by multiplying a quality factor times the Rads.

This QF equates the biological damage to 200-300 Key x-rays wnich can be easily 'l measured. controlled, and reproduced. l III. :oncepts of Exposure and Contamination 10 min.

A. Exposure and contamination are two important Fire Illustra-terms that are used often and easily confusec ,* tions so we will caxe a comparison to fire for simplicity. :gnore the smoke component. If you sit near a fire, you aosorb radiant heat wnich can be controlled by distance.

You also can control it by using a barrier for snielding the heat. This is called expo-sure and is analagous to raciation principles of more energetic radiation.  !! you step into the fire and an emoer sticks to your shoe, you have been contaminated and obviously your exposuretto heat is being dra-matically increased as well. You also can be contaminated by having the wind blow emoers or hot asnes on you.

(Note: There are several other comparisons that can be made if warranted.)

3. Exposure control is managed by three prin- Exposure Control.

ciples alreacy mentioned. The total amuant Time Distance of time you spend in a radiation area or with Shielding a radioactive patient should be short. Only a few feet between you and a source make a dramatic difference in th'e exposure rate.

Shielding with vehicles, concrete, or lead is only practical when you have a very-intense but stationery source of radiation.4 For transferable radioactive contaminat(on.

. coveralls and/or your clothing is ayequate protection wnen used in conjunction"with other protection principles.

C. Contamination control is achieved by assuming Decontamination that everything that touches a contaminated Teams Suiting Up object will become contaminated. That is, you wear protective clothing or protective N/M0023A-4 13 -

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• Attachmant A (Pags 10 of 20) l .

Lecture Time .gligg coveralls with the intent of it potentially being contaminated and then discarding it into receptacles before leaving a restricted area.

(Note: Now that we have cavered the basics, are there any questions before we continue?)

V. Radiation Detection and Instrumentation 5 min. -

A. Let us move on.to radiation detection to -

Survey Meter examine how a survey eeter works when it .

sees' radiation. As radiation passes througn air er any other material, it causes ionizations oy cumping into atoms. A survey Proce Diagram probe works ey collecting the electrons pro-duced from 1:n pairs. If you look at the diagram. the wire in the middle of the proce has a positive charge of about 700-900 volts which strongly attract the negative electrons. -ach gamma ray that penetrates the probe volu=e will send a cascade of electrons to'the probe wire which causes a small surge of electrical current-in the meter circuits. The flow of current is pro-portional to the amount of radiation passing througn the probe. j (Note: Demonstrate with survey meter.)

8. Operation of a survey meter is simple. First Survey Meter Face you check the batteries. If your meter does not respond. check to make sure they have ber:n installed. Next check background: there sr.ould be a few counts per minute audible or about 0.02 mR/hr for natural background. J' o this in a neutral area away from suspected sources. Some meters will have a chgek cource usually mounted on the side of, the meter case. There should be a significant  !

rise in cpm when the probe is placediagainst the source.

N/ MOD 23A-5 Attach;nant. A (Paga 11 'or 20)

Lecture Time Slide-Frisk Diagram C. A frisk survey'is done as in this diagram and Double check snould take about 3 minutes. Patient Diagram suspect areas and have a recorder put the cpm en a patient diagram or a Het Tag.

Met Tag'

1. Cover.the probe with a plastic bag

2. Turn off the audio

3. Do not confuse internal with external radiation Dosiseters and

'4hile survey meters are. rate meters, dosite-D. .

Chargers ters are total collected dose instruments There that show dose accumulated in mil 11Res.

are tnree types with which you should be fami-liar.

Pocket dosimeters are self-reading

enization enameers,that are cnarged just before-use ena disenarge at a rate proportional to the radiation passing'througa them. TLDs are These are small thermoluminescent' dosimeters.

chips which aosorb the energy of radiation as it' passes througn and release it as light when heated in a specially designed reading instru-ment. The last type, which may be available and widely used.in' hospital radiology depart -

ments. 1s the film badge. ' Radiation exposes film and the degree of film blackness is pre-portional to the dose.

2 min.

v. Protective Clothing for Contamination Control Decontamination IProtective clothing is worn to prevent con- Technicians tamination from coming into contact with the skin Suiting Up or being inhaled. At a sinimum. field personnel should have disposable gloves, masks, and booties.

It may not be practical to p.ut on surgical  !

I coveralls or tyveks as will be done in an Emergency Department. The decision should be made  ;

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on practical considerations and time constraints. 2 5 sir.. l yI.

Priorities in Management of Trauma and ,.-

Ranicactive Contamination a Medical Priori-A. First responders who will be transporting ties Contamina-patients need to be familiar with contamina- tion control tion control procedurre and manage the medi-cal problems as well.

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Lecture II"'

111de F,ememoe r ! ! ! The mecical problem is the first priority. The contamination is a secondary consideration handled af ter the patient has l

been stabill:ed.

2. When you get a call involving radioactive materials, have your dispatcher get as much information as possible from personnel at the I scene and pass the information along to the hospital as well. Try to get hold of someone to respond with e. survey meter if possible.

However, a survey meter is noi absolutely necessary to manage the patient.

'. I I . ?reparing the A.?.aulance/ Hospital for Accepting a 2 min.

ntacInsten Injurec Patient' A. While enroute to the scene, get the amoulance prepared by laying floor covers and getting out coverails anc gloves, etc.

B. Cn arrival, proceed to the patient while EMTs "Packagint asking as many questions P.s possible of Patient fellow worxers or bystanders,

1. Treat the injuries first.

2. Once stabill:ed. perform simple decon-tamination if possible: 1.e., removal of clothing (quick anc easy).

3. Transfer to backboard and wrap for transport. A plastic sheet or plain linen will be sufficient. . Plastic may l not be a good idea in warm weather or for j obese patients. , 4 4, Moniter the patient's vital signs as ^

j usual. I

5. A face mask will prevent the patient from interna 11 zing any contaminatiegras long as it does not interfere with b.reathing, t

. 6. Inform the Emergency Departmens ASAP of Hospital Infor- 0 the following: #

mation

a. Number of patients

b. Trauma status i

c. Exposure / contamination c.},

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d. Type of radioactive material

1. Isotope / quantity

2. Physical state

e. Estinate tine of arrival j

7. Check on amoulance entrance if different from usual. Upon arrival, fill in details and stancby for decontaminatica if necessary.

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.C. The hospital needs this infor ation to make a l Hospital ED decision on whether to set up the decen area  !

and mo' a ill:e a f ull team in coveralls or just standby-with a nurse ano a wasn cloth. After notification. the phys 2cian in charge will have to make a cecision. '

D. It may take up to 20 minutes to prep the receiving area and mobilize key personnel on Floor covers.

being taped the Decon Team: longer it during night shif ts down i

and people have to be called in. The key steps to be taken include the following.

1. Traffic control barriers and signs

2. Floor covers laid

3. KVAC systems shut down

4. Equipment moeill:ed to decen area

5. People aco111:ed and suited up i

VIII. Trauma Management. Decontamination, and Sample Taking 5 min.

A. As patients arrive at the.idesignated Decontamination entrance, they should be simultaneously in progress assessed for vital signs and surveyed for contamination.

s B. Manage trauma first. #

,i i C. Once the patient is stabilized then more attention can be given to a thorough survey and decontamination as necessary.

1. Monitors should record initial readings on patient diagrams and final readings ,

when decon is complete to acceptable  !

levels.

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Lecture Time Silde

2. First prevent external contamination from being internalized. Prevent local con-tamination from being generalized.

3. Use water sparingly to prevent splashing.

4. Wipe with damp cloths once and save as sample. Se sure to label everythingtli When suf ficient samples have been taken, dispose wipes ir. proper trash re:ep-tacles. Wiping : ore than one area with a .

cloth r.ay spread contamination rather -

than containing it.

5. Samples snould be carefully bagged and labeled anc suositted for antlysis.

Which spec 1: ens will be held for in-house analysis en which ones will be sent out to reference labs should be werkad out !n advance. Timing of blood samples for CBCs are critical for uncle-body dose assessment and the likely course of patient outcome.

D. Monitors should be rechecking areas on patient for effectiveness of decontamination measures.

Also constant checks should be made of staff and equip =ent for control of any transferrable contamination.

E. At some point. trash receptacles may add to increased background and cause misleading sur-vey readings. Trash should be removed if this becomes a probles.

F. When the patient is medic' ally stable and all external contamination is removed to accep-table levels, the patient can be transferred to a room for further monitoring. " Medical condition still has priority.  :

i G. Consultants should be brought in to assist in strategy for patient observation, total dose assessment, decorporation of any internalized radionuclides, analysis of saaples e and con-sideration for transfer to another facility with greater capabilities.

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I D' Lecture Time Slide  !

IX. Management of Severe Exposures 2 min. .]

A.  !! a severe exposure is suspected, several Severe Exposure measures must te taken to assess and aonitor Clinical Chart the patient's progress. Clinically the patient may have nausea, vomiting and  ;

diarrhea. Psychological support will be needed early on as the patient will real!:c how grave the situation may become.

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3. Acute localized exposures need to be watchen j for loss of function, pain, tingling, and {

tissue perfusion and viability just as in thermal burns. 1 i

Severe whole-body exposures snould be trans- '

ferred to a facility with isolation units for infection control and marrow transplant capa-bilities to head of f crises in the next 30 days.

1. Before transfer, baseline blood work should be drawn and a schedule set up for redraws. Early blood counts will be the most important indicators in pre- j dicting the patient prognosis. I

2. Patient dosimeters should be sent for processing if available, j

3. A professional physicist should be called in to help reconstruct the accident and further quantify actual exposures.

D. All samples collected until tiae of transfer

• should be adequately labeled and any results forwarded with the patient or as soon as possible thereafter. a E. All this is being done to provide h seline information to help manage the lapeiding crisis of bleeding disorders associated with platelet deficiencies. Infections associated with leukopenia, marrow suppression, and pancytopenia.

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Attachment A (Page 16 of 20)

Lecture

) F. It is important to rote that the life-threatening effects of severe exposure may come weeks after tre incident and that ef forts should fi:st be put into trauma sta- i bilization if indicated. If a transfusion is f necessary for blood loss, do not use a rela- l tive. ~ heir arrow may be required for a transplant.later un. Use of their blood would sensitize the recipient to the donors blood components and ensure rejection of a marrow implant at a later time.

X. Emergency Classification Levels 5 min. ECL A. Unusual Event

3. Alert h C. Site Area Emergency C. 'eneral Emergency XI. '* ideo Tape:

. Hospital Eemrgency Department 25 min.

Response to Radiatica Accidents XII. Summary of Group Responsibilities (Note: :nstructor should review the respon- y*

sibilities of the specific audience.)

A. Group 1 - First Responder First Responder Responsibilities

1. Ambulance Preparation

a. Floor c: vers

b. Dispcsaole clothing

c. Survey meters

2. Patient Stabilization

a. BLS first 8

b. Decontamination second .

3. Patient Packaging ,

a. Backboard a

b. Wrap for contamination contrd3

4. Hospital Notification

a. Medical status

b. Radiation information 5 Transportation

a. Monitor patient

b. Alternate ambulance entrance

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h-Attachtlant A' (Paga .17 of '20) 4-Lecture Time Slide A. Environmental Services 10 min. 'ES'Responsi-bilities

1. Access C ntrol

a. Security

b. Internal / parking

.c. Barriers

d. S!rns

e. Verbal directions

2. Decontamination Area Setup I

a. Maintenance / housekeeping

b. Floor covers

c. Isolate environmental air systems in Decontamination Area

d. Mobill:e equipment

3. Contamination Control

a. Barrels

b. Plastic liners

c. Tags / labels

d. Disposaoles supply

4. Disposaoles Supply

a. Towels

b. Coveralls C. Tyveks

d. Gloves / booties /r. asks

5. Waste Disposal

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a. Drum handling d i

b. Labeling i

c. Contact Seabrook Station I

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B. Technical Personnel 10 min. Technical Re'sponsibilities

1. Mobill:e Equipment 1 1

a. Survey meters i

b. Decontamination carts l

2. Provide Monitoring

a. Patient surveys

b. Environmental surveys

c. Direct decontamination efforts

3. Control Contamination l

a. Pestrictsd areas i

b. Monitor staff

c. Proper disposal

4. Assist Sample taking

a. Blood draws

b. Contamination wipes

c. Sample containers

d. Labeling

5. Process Sample Analysis

a. Inhouse analysis

b. Reference laboratory sendout

c. Prepare samples / reports for transfer

d. Assist in sample strategy C. Professional Personnel j 10 min. Professional

1. Incident Assessment-

~

a. Physician / health physicist 4

b. Scope / resources required , i

2. Mobilize Hospital

a. Announce alert code

b. Call in key personnel

c. Set up decontamination area

d. Gather information from scene N/ MOD 23A-13 I

e.

l

. Attachmant A (Pago 19 of 20)

Lecture II5e S11de i

i

3. Direct Response Teams

a. Brief teams on details 'f

b. Help suit up/ issue dosimetry  ;

}

4. Evaluate and Manage Trauma .

a. Medical priorities

b. Contamination secondary

5. Perform Decontamination

a. Direct personnel in techniques  !

b. Cetermine acceptable limits l

?

6. Sampling Strategy

a. Order clood' samples

b. Oversee wipes for analysis j l

7. Patient followup i 1

)

> a. Long-term =onitoring  !

b. Referral

c. Accident reconstruction  !

8. Consultation Requests l l

a. Exposure worxups/: arrow transplants

b. Health physics /desinetr*/  ;

D. Management 10 min. Management Responsibilities

1. Plan Development

a. In print and availa'ble

b. Updated periodically

. c. Key people on review committee

2. Regulatory Compliance ,.

4

a. Meets JCAH ER-5.20

b. NRC C654/ FEMA-REP-1 Planing Standard L

c. FEMA MS-1

d. 10 CFR 50.47 (b) (12) i I

N/ MOD 23A-14

Attachmsnt A-(Paga 20 of 20) '

Lecture Time Slide

3. Community Coordination .

a. Local governr.ent agencies

b. Ambulance companies / EMS c Industry

d. Fire services

-e. Rescue services

4. Training Programs

a. Meet criteria of regulations '

b. Periodically offered

c. Qualified instructors

5. Crills/Critfques

a. Meet criteria

b. Test systems adequately (3 shifts)

c. Critique for improvement

d. Deficiencies corrected i 4

6. Systems Maintenance

a. Decontamination area properly designed

b. KVAC systems isolated

c. Equipment available  !

d. Survey r.eter in operation / calibrated

e. Disposables stockpiled l

7. Plan Implementation

a. Hospital alerting tapability

b. Mobilization proceduces (3 shifts)

c. Call lists staff / consultants /

emergency services

d. Patient classification / flow chart XIII. Questions and Course Evaluation l

N/ MOD 23A-15