ML20247F894
| ML20247F894 | |
| Person / Time | |
|---|---|
| Site: | Seabrook  |
| Issue date: | 04/19/1989 |
| From: | Federal Emergency Management Agency |
| To: | |
| References | |
| CON-#289-8640, RTR-NUREG-0654, RTR-NUREG-654 OL-S-007, OL-S-7, NUDOCS 8905300215 | |
| Download: ML20247F894 (7) | |
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'89 y 22 M :2h0V 131935 GUIDANCE MEMORANDUM MS-1 MEDICAL SERVICES h.
t Purpose This Guidance Memorandum (GM) provides interpretation and clarification of requirements contained in the N" clear Regulatory Comission rule,10 CFR 50.47 (b)(12)andtheassociatedguidanceinNUREG-0654/TEMA-REP-1, Revision 1,re-lated to the provision of medical services for members of the general public.
}ackoround The background is c0ntained in a policy statement from the Nuclear Regulatory Commission (NRC) titled " Emergency Planning - Medical Services" (51 FR 32904).
In this policy statement, NRC states its belief that 10 CFR 50.47(b)TT2)
(" 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 offsite radiation following an accident at a nuclear power plant. As used in 10 CFR 50.47(b)(12) and planning Standard "L" of NUREG-0654/ FEMA-REP-1, Revisicn 1, the tem " contaminated injured" means
- 1) contaminated and otherwise physically injured; 2) contaminated and exposed to dangerous levels of radiation; cr 3) exposed to dangerous levels of radiation.
Guidance 10 CFR 50.47 (b)(12) requires that " Arrangements are made for contaminated injured individuals." In its policy statement the NRC determined 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 e nuclear power plant. The following guidance applies to the eval-untion of the medical services aspects of State and local emergency plans under the criteria in NUREG-0554/TEMA-REP-1.
Standards, Evaluations Criteria, Areas of Reviews and Acceptance Criteria A.
Assignment of Responsibility (Organization Control)
Planning Standard l
Primary responsibilities for emergency response by the nuclear facility licensee, and by State and local organizations within the Emergency Planning Zones have been assigned, the emergency responsibilities of the various sup-porting organizations have been specifically established, and each principal response organization has staff to respond and to augment its initial response 6
on a continuous basis.
C905300215 890419 PDR ADOCK 05000443 G
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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 H
Planning Zones. The agreements shall identify the emergency mea _sures to be provided and the mutually acceptable criteria for theirJmplementation, and specify the arrangements for exchange of informatiQ.D. 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 agreements. The signature page fomat is appropriate for organizations where
,j response functions are covered by laws, regulations or executive orders where
- j separate written agreements are not necessary.
Areas for Review and Acceptance Criteria State or local governments should obtain written agreements with the listed medical facilities (Planning Standard L. Evaluation Criteria 1 and 3) and trans,
'por_tatimLproviders (Planning Standard L. Evaluation Criterion 4).
The written agreements should contain simple assurances that the providers have ade_qugf,.
technical information (e.g. treatment protocols) and trea.tm.ent capabilities for
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handling "contam W TEd injured" individuals. An indicHion oTJbEt Chi:imits:on on Accreditation of Hospitals (JCAH) accreditation will suffice for such assurance.
(Note:
Veterans Administration (VA), military and other government hospitals are not usually accredited by JCAH but usually have the desired capabilities.)
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 effortTire not successful in a particular case, the lirensershall provide or arrange for adequate compensatory measures, e.g., obtain written agreements with other providers or provide temporary field medical care.
e L.
Medical and Public Health Support Planning Standard Arrangements are made for m.efcal wrvices for contaminated injured individuals.
L.I. Evaluation Criterion Each organization shall arrange for local and backup hospital and medica.1 services having the capability for e0a1Ua_t15n_0.f_raMon_ exposure _and_up_take including assurance that persons pr671 din'g these services are adequately
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_ prepared to handle contaminated individuals.
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Areas for Review and Acceptance Criteria There should be one primary local hospital and one backup hospital for each site for the evaltiation and emergency treatment of " contamination injured"
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members of the general public. Hospitals are generally distributed proportional to the population. Thus, at sites with low 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 milita_ry hospitals and other emergency medical services facilities wfthin the State or contiFTcus 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
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monitor contaminated personnel, and have facilities and tr'ained personnel able
~ to caWfor cont'aminated in~jored 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 carble of handling " contaminated injured" patients.
In the event that local and regional 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 with headquarters in Rockville, Maryland.
L.4. Evaluation Criterion Each organization shall arrange for transporting victims of radiological acci-dents to medical support facilities.
Areas for Review and Acceptance Criteria 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-I vals, specialized transportati6n 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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Planning Standard O.
Radiological Emergency Response Training Radiological emergency response training is provided to those who may be called on 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 recraining programs (including the i
scope, nature and frequency) shall be provided in the following categories:
h.
Medical support personnel Areas for Review and Acceptance Criteria Ee d 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 contamination control. Examples include but are not limited to:
1.
FEMA handbook, videotape, slides and instruction manual titled "Hcspital Emergency Department Management of Radiation Accidents," SM 80/1984.
2.
' Courses from The Radiation Emergency Assistance Center / Training-Site (REAC/TS) at Oak Ridge Associated Universities.
c.
3.
Audiocassette and text course, " Radiation Accident Preparedness: Medical and Managerial Aspects" by Science-Thru-Media Inc., 303 Fifth Avenue, Suite 803, New York,fiY 10016.
N. ~ Exercises and Drills planning Standard Periodic exercises are (will be) aonducted 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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.. 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
-annva4* 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 of the required biennial aanwa4* 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.I.) 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 appropriate hospital.
If State or local governments cannot provide for the conduct of the drills, the licensee shall provide for the con-duct of such drills.
If good faith efforts are not successful in 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.
J Pla,ns 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 incorporated into GM pR-1.
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NRC Coordination This Guidance Memorandum has been prepared in coordination'with the NRC staff.
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As noted.in the referenced NRC Policy Sta;.. ment, 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 Commission.
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