ML12004A014

FEMA, Transmittal of Braidwood Station Medical Services Drill Final After/Action Report/Improvement Plan Conducted on September 23, 2011

ML12004A014
Person / Time
Site:	Braidwood
Issue date:	12/22/2011
From:	Velasquez A US Dept of Homeland Security, Federal Emergency Management Agency
To:	Document Control Desk, Office of Nuclear Reactor Regulation
References
Download: ML12004A014 (56)

Text

U.S. Department of Homeland Security Region V 536 South Clark Street, Floor 6 Chicago, IL 60605}FEMA AFD S-DEC 2 2 2011 NRC Headquarters Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001 To Whom It May Concern: Enclosed is a copy of the Final After Action Report / Improvement Plan for the September 23, 2011, Radiological Emergency Preparedness Medical Services Drill for the Braidwood Station.No Deficiencies, Areas Requiring Corrective Action (ARCA), or Planning Issues were identified during this drill.Copies of this report were transmitted to the DHS/FEMA Headquarters, the Nuclear Regulatory Commission Region III Office, and the State of Illinois.If you have any questions, please contact William King, Chairman, Regional Assistance Committee, DHS/FEMA, Region V, at (312) 408-5575 or Deborah Fulk, Technological Hazards Specialist, DHS/FEMA, Region V at (312) 408-5547.Sincerely, Andrew Velasquez III Regional Administrator Enclosure (1)www.fema.gov Braidwood Station After Action Report/Improvement Plan Drill Date -September 23, 2011 Radiological Emergency Preparedness (REP) Program ,. FEMA December 12, 2011 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station I This page is intentionally blank.I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station Braidwood Station After Action Report/Improvement Plan Published December 12, 2011 Contents Executive Summary 3 Section 1: Exercise Overview 8 1.1 Exercise Details 8 1.2 Exercise Planning Team Leadership 8 1.3 Participating Organizations 10 Section 2: Exercise Design Summary 11 2.1 Exercise Purpose and Design 11 2.2 Exercise Objectives, Capabilities and Activities 11 2.3 Scenario Summary 11 Section 3: Analysis of Capabilities 12 3.1 Drill Evaluation and Results 12 3.2 Summary Results of Drill Evaluation 12 3.3 Criteria Evaluation Summaries

.15 3.3.1 Illinois Jurisdictions 15 3.3.1.1 State of Illinois -Riverside Medical Center -Medical 15 Service -Transportation 3.3.1.2 State of Illinois -Riverside Medical Center -Medical 22 Service -Facility Section 4: Conclusion 34 Appendix A: Drill Evaluators and Team Leaders 35 Appendix B: Exercise Plan 36 Appendix C: Summary and Injects 41 1 I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station This page is intentionally blank.I I 2 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station EXECUTIVE

SUMMARY

On September 23, 2011, the U.S. Department of Homeland Security's (DHS) Federal Emergency Management Agency (FEMA), Region V, evaluated a Medical Services (MS-I) Drill at the Riverside Medical Center associated with the Braidwood Station. The purpose of the MS-1 Drill was to assess the ability of offsite agencies to respond to a medical emergency involving a potentially radiologically contaminated member of the public.DHS/FEMA wishes to acknowledge the efforts of the personnel from the Illinois Emergency Management Agency, Riverside Ambulance, and Riverside Medical Center.Protecting the public health and safety is the full-time job of some of the exercise participants and an additional assigned responsibility for others. Still others have willingly sought this responsibility by volunteering to provide vital emergency services to their communities.

The following criteria, which are part of the six Exercise Evaluation Areas described in Federal Register notice [67 FR 20580-20602], April 2002, which-amends the FEMA REP-14, Radiological Emergency Preparedness Exercise Manual, were evaluated during the medical services drill.Criterion 1 .d. 1 -At least two communication systems are available, at least one operates properly, and communication links are established and maintained with appropriate locations.

Communications capabilities are managed in support of emergency operations.

Criterion i.e. 1 -Equipment, maps, displays, dosimetry, potassium iodide (KI), and other supplies are sufficient to support emergency operations.

Criterion 3.a. I -The OROs issue appropriate dosimetry and procedures, and manage radiological exposure to emergency workers in accordance with the plans and procedures.

Emergency workers periodically and at the end of each mission read their dosimeters and record the readings on the appropriate record or chart.Criterion 6.d. 1 -The facility/ORO has the appropriate space, adequate resources, and trained personnel to provide transport, monitoring, decontamination, and medical services to contaminated injured individuals.

3 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station The State and local organizations demonstrated knowledge of and adequately implemented organizational emergency response plans and procedures.

!I There were no Deficiencies identified as a result of this drill. There.were no Areas Requiring Corrective Action (ARCAs) identified during this drill. There were no previous Deficiencies or ARCAs to be corrected during this drill.I INTRODUCTION

-EXERCISE BASIS I On December 7, 1979, the President directed FEMA to assume the lead responsibility for all offsite nuclear planning and response.

DHS/FEMA's activities are conducted pursuant to 44 Code of Federal Regulations (CFR) Parts 350 "Review and Approval of State and Local Radiological Emergency Plans and Preparedness", 351 "Radiological Emergency Planning and Preparedness" and 352 "Commercial Nuclear Power Plants: Emergency Preparedness Planning." These regulations are a key element in the Radiological Emergency Preparedness (REP) Program that was established following the Three Mile Island Nuclear Station accident in March 1979. U The FEMA Rule 44 CFR 350 establishes the policies and procedures for DHS/FEMA's initial and continued approval of State and local governments radiological emergency planning and preparedness for commercial nuclear power plants. This approval is contingent, in part, on State and local governments' participation in joint exercises with licensees.

DHS/FEMA's responsibilities in radiological emergency planning for fixed nuclear facilities include the following:

• Taking the lead in offsite emergency planning and in the review and evaluation of RERPs and i procedures developed by State and local governments;

• Determining whether such plans and procedures can be implemented on the basis of observation and evaluation of exercises of the plans and procedures conducted by State and local governments; I-Responding to requests by the U.S. Nuclear Regulatory Commission (NRC) pursuant to the I 4I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station Memorandum of Understanding between the NRC and FEMA dated June 17, 1993 (Federal Register, Vol. 58, No. 176, September 14, 1993); and* Coordinating the activities of Federal agencies with responsibilities in the radiological emergency planning process:-U.S. Department of Agriculture,-U.S. Department of Commerce,-U.S. Department of Energy,-U.S. Department of Health and Human Services,-U.S. Department of the Interior,-U.S. Department of Transportation,-U.S. Environmental Protection Agency,-U.S. Food and Drug Administration, and-U.S. Nuclear Regulatory Commission.

Representatives of these agencies serve on the DHS/FEMA Region V Regional Assistance Committee (RAC), which is chaired by DHS/FEMA.Formal submission of the RERPs for the Braidwood Station to FEMA Region V by the State of Illinois and involved local jurisdictions occurred on January 9, 1987. Formal approval of these RERPs was granted by FEMA on April 15, 1988, under 44 CFR 350.A Medical Services (MS-I) Drill was conducted on September 23, 2011, and evaluated by DHS/FEMA to assess the capabilities of State and local offsite emergency preparedness organizations in implementing their RERPs and procedures to protect the public health and safety during a radiological emergency involving the Braidwood Station. The purpose of this report is to present the Drill results and findings on the performance of the Offsite Response Organizations (ORO) that took part in this Drill.The findings presented in this report are based on the evaluations of the Federal evaluation team, with final determinations made by the DHS/FEMA Region V RAC Chairperson.

The criteria utilized in the FEMA evaluation process are contained in: 5 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station* NUREG-0654/FEMA-REP-1, Rev. 1, "Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness in Support of Nuclear Power Plants," November i 1980;I-FEMA-REP-14, "Radiological Emergency Preparedness Exercise Manual," September 1991;and 5* FEMA "Radiological Emergency Preparedness:

Exercise Evaluation Methodology; Notice" as published in the Federal Register Notice, Vol. 67, No. 80, dated April 25, 2002. i Section 1 of this report, entitled "Exercise Overview", presents information pertaining to the team that planned and coordinated the exercise.

This section also provides listing of all participating jurisdictions and functional entities that were evaluated.

Section 2 of this report, entitled "Exercise Design Sunimary", contains the purpose and design of the exercise, a description of the plume pathway EPZ and presents basic information and data relevant to the exercise scenario.I Section 3 of this report, entitled "Analysis of Capabilities," presents detailed information on the demonstration of applicable exercise criteria at each jurisdiction or functional entity evaluated in a jurisdiction-based, issues-only format. This section also contains:

(1) descriptions of all Deficiencies and ARCAs (if any) assessed during this exercise, recommended corrective actions, and the State and local governments schedule of corrective actions, if applicable, for each i identified exercise issue; and (2) descriptions of unresolved ARCAs assessed during previous exercises and the status of the OROs efforts to resolve them.Section 4 of this report, entitled "Conclusion" presents the DHS/FEMA summary of overall exercise conduct and results as evaluated against the requirements of 44 CFR 350.I EMERGENCY PLANNING ZONE (EPZ) DESCRIPTION The Braidwood Station is located on a 4,162 acre site in Reed Township in southwest Will County, two miles south of Braidwood, Illinois, and three miles west of the Kankakee River. The station site is relatively flat with an elevation of 589 feet above sea level.6 I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station The population distribution in the 10-mile Emergency Planning Zone (EPZ) surrounding the Braidwood Station is relatively low. The year 2000 total population data is 36,493 persons living in the following protective action Sub-Areas 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 and 16 which are included within the 10-mile EPZ.The primary land use around the Braidwood Station is agriculture, with cash grain crops of corn and soybeans.

The closest industries are located in the communities of Wilmington, Gardner, and Coal City. There are six recreational facilities in the EPZ which can accommodate between 1000 and 3000 people each.Major transportation facilities in the Braidwood Station EPZ are limited to Interstate 55, which passes one and one-half (1 V 2 ) miles west of the Station itself, and five railroads.

The Railroads are: the Union Pacific Company which is one (1) mile west of the Station; the Burlington Northern and Santa Fe Railway Company which is four (4) miles northwest of the Station; the Norfolk Southern Railway Company which is nine and one-half (9/) miles south of the Station;the Elgin, Joliet and Eastern Railway Company which is ten (10) miles northwest of the Station;and the CSX Transportation, Inc. which is fourteen (14) miles northwest of the Braidwood Station.7 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station 3 SECTION 1: EXERCISE OVERVIEW I 1.1 Exercise Details Exercise Name I Braidwood Station Type of Exercise Drill Exercise Date September 23, 2011 Program 3 Department of Homeland Security/FEMA Radiological Emergency Preparedness Program Scenario Type Radiological Emergency 1.2 Exercise Planning Team Leadership William King Radiological Assistance Committee DHS/FEMA Chairperson 536 South Clark Street Chicago, Illinois, 60605 312-408-5575 William.King@dhs.gov 3 Dwaine Warren Exercise Director DHS/FEMA Supervisory REP Team Leader I 536 South Clark Street I Unclassified Radiological Emergency Preparedness Prograqm (REP)After Action Report/Improvement Plan Braidwood Station Chicago, Illinois, 60605 312-408-5342 Dwaine.Warren@dhs.gov Deborah Fulk Site Specialist DHS/FEMA Technological Hazards Program Specialist 536 South Clark Street Chicago, Illinois, 60605 312-408-5547 Deborah.Fulk@dhs.gov Joni Estabrook State Controller Illinois Emergency Management Agency Nuclear Safety Sr. Emergency Response Coordinator 1035 Outer Park Drive Springfield, Illinois, 62704 217-524-0888 Joni.Estabrook@illinois.gov Kathy Allen State Controller Illinois Emergency Management Agency Manager, HazMat Section 1035 Outer Park Drive Springfield, Illinois, 62704 217-524-0888 Kathy.Allen@illinois.gov 9

Unclassified U Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station 1.3 Participating Organizations Agencies and organizations of the following jurisdictions participated in the Braidwood Station drill: State Jurisdictions Illinois Emergency Management Agency Riverside Medical Center Riverside Ambulance Private Organizations I Exelon Nuclear I U I I I I I I I 1 I I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/improvement Plan Braidwood Station SECTION 2: EXERCISE DESIGN

SUMMARY

2.1 Exercise Purpose and Design On September 23, 2011, the DHS/FEMA Region V Office evaluated a Medical Services (MS-I)Drill for the Braidwood Station. The purpose of the MS-I Drill was to assess the ability of offsite agencies to respond to a medical emergency involving a potentially radiologically contaminated member of the public. The MS-I Drill was held in accordance with DHS/FEMA policies and guidance concerning the exercise of State and local radiological emergency response plans.2.2 Exercise Objectives, Capabilities and Activities 2.3 Scenario Summary Appendix C "Injects and Summary", contains a summary of the Exercise Scenario, a simulated sequence of events that was used as a basis for invoking emergency response actions by Offsite Response Organizations (OROs) in the MS-1 Drill.During the exercise, controllers from the State of Illinois provided inject messages containing scenario events and/or relevant data to those persons or locations who would normally receive notification of such events. These inject messages were the method used for invoking additional specific response actions by OROs.11 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station SECTION 3: ANALYSIS OF CAPABILITIES 3 3.1 Drill Evaluation and Results Contained in this section are the results and findings of the evaluation of all jurisdictions B and functional entities that participated in the September 23, 2011, Medical Services (MS-i)Drill conducted to test the offsite emergency response capabilities of State and local 1 governments in the EPZ surrounding the Braidwood Station.U Each jurisdiction and functional entity was evaluated based on its demonstration.

of exercise criteria delineated in Federal Register Notice: Vol. 67, No. 80, dated April 25, 3 2002. Detailed information on the exercise criteria and the extent-of-play agreements used in this exercise are found in Appendix B "Exercise Plan" of this report.3.2 Summary Results of Drill Evaluation The matrix presented in Table 3.1, on the following page(s) presents the status of all exercise criteria from Federal Register Notice Vol 67, No. 80, dated April 25, 2002, 3 which were scheduled for demonstration during this drill by all participating jurisdictions and functional entities.

Exercise criteria are listed by number and the demonstration status of those criteria is indicated by the use of the following letters." M -Met (No Deficiency or ARCAs) 3" D -Deficiency assessed 3* A -ARCA(s) assessed or unresolved ARCA(s) from prior exercise(s)" N -Not Demonstrated I" Blank -Not scheduled for demonstration i 12I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/improvement Plan Braidwood Station Table 3.1 -Summary of Drill Evaluation DATE: 2011-09-23 (SITE: Braidwood Station, IL M: Met, A: ARCA, D: Deficiency, P: Plan Issue, N: Not Demonstrated Emergency Operations Management Mobilization Wa 1 Facilities Ib 1 Direction and Control I0 c1 Communications Equipment idl M M Equip & Supplies to support operations lel M M Protective Action Decision Makin"g Emergency Worker Exposure Control 2a I Radiological Assessment and PARs 2b]Decisions for the Plume Phase -PADs 2b2 PADs for protection of special populations 2cl Rad Assessment and Decision making for Ingestion Pathway 2dl Rad Assess/Decision making concerning Relocation, Reentry, and Return 2el Protective Action Implementation' Implementation of emergency worker exposure control 3al M Implementation of KI decision 3bl Implementation of protective actions for special populations

-EOCs 3cl Implementation of protective actions for Schools 3c2 Implementation of traffic and access control 3dl Impediments to evacuation are identified and resolved 3d2 Implementation of ingestion pathway decisions

-availability/use of info 3el Materials for Ingestion Pathway PADs are available 3e2 Implementation of relocation, re-entry, and return decisions 3fl FieldMeasurement and Analysis .Adequate Equipment for Plutme Phase Field Measurements 4al Field Teams obtain sufficient information 4a2 Field Teams Manage Sample Collection Appropriately 4a3 Post plume phase field measurements and sampling 4bl Laboratory operations 4c Emergency Notification and PublictInfoV .. ! *: "*:.. .'Activation of the prompt alert and notification system 5al Activation of the prompt alert and notification system -Fast Breaker 5a2 Activation of the prompt alert and notification system -Exception areas 5a3 Emergency information and instructions for the public and the media 5bl Support Operations/Facilities

• .::.Mon/Decon of evacuees and EWs and registration of evacuees 6al Mon/Decon of EW worker equipment 6bi Temporary care of evacuees 6ci Transportation and treatment of contaminated injured individuals 6dI M M 13 I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station I I I 14 I I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station 3.3 Criteria Evaluation Summaries 3.3.1 Illinois Jurisdictions 3.3.1.1 State of Illinois -Riverside Medical Center -Medical Service -Transportation Criterion 1.d.1: As part of the Braidwood Station Radiological Emergency Preparedness Exercise, the State of Illinois demonstrated that at least two communications systems were available, at least one operated properly, and communication links were established with appropriate locations.

The Medical Services (MS-i) Drill was conducted on Friday, September 23, 2011, during an out-of-sequence activity at the Riverside Medical Center, 650 North Wall Street, Kankakee, Illinois, from approximately 0900 hours0.0104 days <br />0.25 hours <br />0.00149 weeks <br />3.4245e-4 months <br /> to 1110 hours0.0128 days <br />0.308 hours <br />0.00184 weeks <br />4.22355e-4 months <br />.The Riverside Ambulance crew was equipped with an 800 MHz radio system, which had the capability to have direct contact with the 911 dispatch center and the Riverside Medical Center.Back-up communication was cellular telephones.

The initial call made to the Riverside Medical Center was through the 800 MHz radio system.All activities described in the demonstration criterion were carried out in accordance with the plan, procedures and extent-of-play agreement.

Criterion 1.e.1: As part of the Braidwood Station Radiological Emergency Preparedness Exercise, the State of Illinois demonstrated that there was sufficient equipment, maps, displays, dosimetry, potassium iodide (KI), and other supplies to support emergency operations.

The Medical Services (MS-i) Drill was conducted on Friday, September 23, 2011, during an out-of-sequence activity at the Riverside Medical Center, 650 North Wall Street, Kankakee, Illinois, from approximately 0900 hours0.0104 days <br />0.25 hours <br />0.00149 weeks <br />3.4245e-4 months <br /> to 1110 hours0.0128 days <br />0.308 hours <br />0.00184 weeks <br />4.22355e-4 months <br />.The Illinois Emergency Management Agency (IEMA) Medical Radiation Technician (MRT)who participated in the drill wore a Luxel-Landauer Optically Stimulated Luminescent Dosimeter personal dosimeter.

15 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station The MRT had a hospital response kit. He stated that the kit is stocked and available at all times for use in the event of a radioactive emergency accident.

The kit was a black carrying case with equipment that included:

one Ludlum Model 2441-3 Digital Radiation Scaler/Ratemeter, last 3 calibrated December 1, 2010 with a calibration due date of December 1, 2011, one Ludlum Model 44-10 Gamma Radiation Scintillator, one Ludlum Model 44-9 Alpha Beta Gamma Radiation Pancake Probe G-M, one Bicron Micro-Rem Radiation Area Monitor, last calibrated I August 8, 2011, with a calibration due date of August 8, 2012, one set of headphones and two"D" cell batteries.

In order to detect contamination on an individual, the MRT used the Ludlum 3 Digital Radiation Ratemeter and in order to detect radiation in the area, the MRT used the Bicron Radiation Area Monitor.The IEMA MRT also carried a red duffel bag that contained additional equipment and other support supplies which included disposable gloves, scrubs, hair covers, booties, plastic bags, scissors, face masks, masking tape, clipboards, pens, writing paper and a Reception Center Monitoring/Action Log Form.The Riverside Ambulance crew was equipped with sufficient equipment and supplies needed to 3 support emergency operations.

The equipment and supplies available consisted of the necessary medical supplies and equipment that was needed to care for an injured victim that was being transported to the Riverside Medical Center and for use of adequate contamination control. The l ambulance service was not responsible for radiological monitoring of the patient. Protective clothing worn by the EMS Technicians included:

shoe covers, dust masks, eye covers and latex 5 gloves. Contamination control supplies included wipes and several sheets for wrapping the patient. The instruments passed an operational battery test and a source response check prior to 5 use by the IEMA MRT.All activities described in the demonstration criterion were carried out in accordance with the I plan, procedures and extent-of-play agreement.

Criterion 6.d.l: As part of the Braidwood Station Radiological Emergency Preparedness Exercise, the Illinois 5 Emergency Management Agency, the Riverside Ambulance crew and the Riverside Medical Center located at 350 N. Wall Street, Kankakee, Illinois demonstrated that the facility and offsite response organizations had the appropriate space, adequate resources, and trained personnel to 165 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station provide transportation, monitoring decontamination, and medical services to contaminated injured individuals.

The capability to demonstrate the adequacy of vehicles, equipment, procedures, and personnel for transporting contaminated injured or exposed individuals was demonstrated by the Riverside.

Ambulance crew.The Medical Services (MS-l) Drill was conducted on Friday, September 23, 2011, at the Riverside Medical Center.In accordance with the extent-of-play agreement, two ambulance crew personnel and an ambulance from the Riverside Ambulance Service, and one Illinois Emergency Management Agency (IEMA) Medical Radiation Technicians (MRT), participated in the Medical Services (MS-i) Drill.The scenario for the MS-1 Drill was the Braidwood Station had declared an Emergency Classification Level of a General Emergency.

The emergency alert sirens sounded, the public was directed to evacuate the affected areas and to report to the reception center (Kankakee Community College) in Kankakee, Illinois.

The scenario was based on a local resident who was attempting to evacuate the emergency planning zone. While evacuating the area, the resident had a flat tire and injured his hand, which dramatically slowed him leaving the area. He eventually reported to the local reception center. Radiation monitoring and if necessary, decontamination of evacuees was provided for at these facilities by staff from IEMA under the Illinois Plan for Radiological Accidents (IPRA).Upon arrival to the reception center, the resident tripped the portal monitor and was asked by IEMA staff to step aside for personal monitoring.

IEMA personnel noticed the resident was bleeding and inquired regarding the injury. IEMA staff realized the injury required more than basic first aid, called 911, and notified the reception center supervisor.

Riverside Ambulance was dispatched to the reception center to which an IEMA staff member accompanied the resident (now a patient) and ambulance crew.For the purpose of the exercise, the Kankakee Community College Reception Center was set-up at the Riverside Ambulance bay. The ambulance bay was approximately 1.5 miles from the Riverside Medical Center.17 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station At 0922 hours0.0107 days <br />0.256 hours <br />0.00152 weeks <br />3.50821e-4 months <br />, upon arrival at the reception center, the evaluator observed an IEMA MRT opening the black carrying case containing the survey meters. For demonstrations purposes, the IEMA MRT checked the survey equipment that would be used during the drill. Both survey U meters were checked to ensure that they contained fresh batteries.

Prior to the drill, the survey meters were turned on and allowed to warm up. Survey instruments used included:

Bicron Micro-R area meter, last calibrated on August 8, 2011, and due for calibration on August 8, 2012, and Ludlum 2241-3 digital scalar/rate meter with pancake probe, last calibrated on December 1, 2010, with the next calibration due on December 1, 2011. The instruments passed an operational test and a source response check prior to use by the IEMA RMT.The IEMA MRT took background readings in the area of the reception center that would be used for patient transfer and treatment.

While using the Bicron Micro-R meter, readings of 30 counts per minute were noted in the reception center. This level was established as background to be used for establishing the decontamination level. The State of Illinois had established a decontamination level of two times the background.

At 0930 hours0.0108 days <br />0.258 hours <br />0.00154 weeks <br />3.53865e-4 months <br />, a reception center worker placed a call to the 911 center. According to 3 procedures, the 911 dispatch center would notify the Riverside Medical Center and the Riverside Ambulance to alert them to transport and prepare to care for an injured contaminated patient. At 0932 hours0.0108 days <br />0.259 hours <br />0.00154 weeks <br />3.54626e-4 months <br />, the ambulance crew from the Riverside Ambulance received a call from the 911 dispatch center which deployed them to the reception center. According to drill records, at 0933 hours0.0108 days <br />0.259 hours <br />0.00154 weeks <br />3.550065e-4 months <br />, the 911 dispatch contacted the Riverside Medical Center and informed the medical center I to prepare to receive a possibly contaminated injured patient. The medical center duty nurse was informed that the patient was slightly bleeding from embedded glass in his hand, however he was 3 stable.Although the IEMA MRT was taking background readings of the area, he was attentive to the i patient's needs. As he was waiting for the ambulance to arrive, the MRT directed the patient to a chair and he began to monitor the patient for contamination.

Monitoring of the patient was 3 conducted in a low radiation background area. The patient was examined using a Ludlum Model 2241-3 survey instrument, equipped with a pancake probe, speaker and audible alann. The monitoring techniques used were slow and orderly, with proper positioning of the probe for personnel monitoring.

Prior to the drill, the patient was issued a paper body suit. Contamination was found on the patient and documented on a Reception Center Monitoring/Action Log Form as 18 1 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station follows: right palm -1800 cpm; left palm -1600 cpm; backside of pants -1000 cpm; pants left knee -800 cpm; pants right knee -800 cpm; right temple -400 cpm; shoes prior to being removed -1200 cpm.Personal information and comments which contained information regarding the victim's injury also were recorded on the form; for instance, the victim suffered current pain and bleeding to right arm, when question, he stated that the level of his pain on a scale of one to 10 was eight.The IEMA MRT took the victim's vital signs and recorded that his level of consciousness was: alert and oriented, respirations:

30, pulse: 80, skin: normal, pupils: PERL, blood pressure: 120/70, visual: bleeding and swelling on right hand.At 0938 hours0.0109 days <br />0.261 hours <br />0.00155 weeks <br />3.56909e-4 months <br />, the Riverside Ambulance crew arrived at the reception center. The ambulance crew was given a status update of the patient's condition by the IEMA MRT. The ambulance crew took universal contamination control precautions while treating the patient. They wore booties, hair protection, face and eye protection, and rubber gloves.After thoroughly examining the patient, both the IEMA MRT and ambulance crew agreed that due to the condition of the patient injuries, decontamination should be delayed until arrival at the medical center. The ambulance crew began to assess the patient's level of consciousness, level of pain and vital signs. The ambulance crew removed a gurney from the ambulance and rolled it up into the bay designated as the clean zone. The ambulance crew crossed the line to enter the dirty zone. They were briefed by the MRT as to what areas of the patient's body was possibly contaminated.

The ambulance crew requested a pair of scissors in order to cut the clothes from the patient's body. The ambulance crew started at the top and cut down along the patient's side in order to remove the body suit. In order to avoid contamination, his clothes were removed and bagged.The MRT instructed the patient to remove both shoes and he was issued house shoes, this was done to eliminate most of the contamination on his feet. The ambulance crew irrigated the patient's wound and covered it with bandage. The MRT conducted a survey on himself prior to entering the clean zone to assist the ambulance crew with the gurney. The gurney was covered with two white sheets and wheeled up to the line. At 0940 hours0.0109 days <br />0.261 hours <br />0.00155 weeks <br />3.5767e-4 months <br />, the ambulance crew changed the bed gurney into a chair gurney and the victim was instructed to place his feet on the step-off pad and sit on the gurney. The chair gurney was transformed into a bed gurney. The patient was wrapped in the two sheets and secured on the gurney with three straps.19 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station After securely strapping the patient on the gurney, the ambulance crew was questioned regarding spreading contamination from the gloves to the gurney. The ambulance crew changed gloves and stated that due to contamination, they would wipe the rails on the gurney down and replace the straps. This action was simulated prior to the patient entering the ambulance.

Also before the patient entered the ambulance, the ambulance crew covered the entire back of the ambulance with several large sheets. This was done to avoid contaminating other parts of the ambulance.

At 0958 hours0.0111 days <br />0.266 hours <br />0.00158 weeks <br />3.64519e-4 months <br />, the patient was placed in the ambulance.

Prior to departure, the ambulance crew changed gloves and placed them, and all used equipment, into a bag. The contaminated clothing and equipment were bagged and was left at the reception center to be later handled by the Utility. Before exiting the reception center, the ambulance crew recorded the patient's contamination information provided by the IEMA MRT and took vital signs of the patient. At this point, the patient's level of consciousness was: alert and oriented, respirations:

30, pulse: 78, skin: normal, pupils: PERL, blood pressure 116/62, visual: bleeding and swelling of right hand. At 1003 hours0.0116 days <br />0.279 hours <br />0.00166 weeks <br />3.816415e-4 months <br />, the ambulance departed from the reception center.The IEMA MRT (the controller and the evaluator) rode with the ambulance crew to the medical center. The ambulance crew member riding in the back of the ambulance provided medical care and gathered personal information from the patient to relay to the medical center.At 1006 hours0.0116 days <br />0.279 hours <br />0.00166 weeks <br />3.82783e-4 months <br />, the ambulance crew communicated the patient's condition with Riverside Medical Center Emergency Department staff via cell phone. The ambulance crew reported that the ambulance was enroute with an injured and possibly contaminated patient. He briefed the medical center of the patient's radiological contamination readings and the location of his contamination, his level of consciousness, vital signs, and stated that the patient's contamination was contained because he was securely wrapped. The ambulance crew further reported the patient's respiratory rate, pulse, skin color, temperature, blood pressure and patient's history. The ambulance crew gave an estimated time of arrival of five minutes. Documentation indicated that the medical center was informed they would be receiving a contaminated patient from at the Kankakee Community College Reception Center in advance of the ambulance arrival.At 1007 hours0.0117 days <br />0.28 hours <br />0.00167 weeks <br />3.831635e-4 months <br />, the Riverside Ambulance arrived at the Riverside Medical Center. The Emergency Department Staff and the medical center's MRT met the ambulance crew in the receiving area. The ambulance was directed to a designated area to prevent unauthorized entry and maintain control of the area. The patient was carefully removed from the ambulance and the 20 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station ambulance crew briefed the Emergency Department staff on the patient's condition.

The IEMA MRT updated the medical center's MRT regarding the patient's area of contamination.

Prior to the patient being transferred from the ambulance gurney to the medical center's gurney, the JEMA RMT provided the patient's information, which was recorded earlier on a Reception Center Monitoring Center Monitoring/Action Log Form, to the Riverside Medical Center Staff.After the patient was transferred to medical center personnel, the ambulance crew, equipment, and ambulance were surveyed for contamination by the IEMA MRT. The sheets covering the ambulance gurney were removed and the ambulance crew explained that the gurney's bed pads would be wiped down and if contamination still remained, the pad could be permanently removed because of the Velcro replacement.

The ambulance crew and IEMA MRT displayed awareness for the location of potential contamination.

For example, upon arriving to the medical center, it was noted that one of the ambulance crew failed to put on a new pair of gloves after placing the patient in the ambulance.

The ambulance crew stated that he announced that he was simulating wearing gloves. However, neither the controller or the evaluator heard his announcement.

The controller's reply to the ambulance crew was gloves are not simulated.

Therefore, he was surveyed by the MRT and directed into the hospital for a complete shower.The remaining ambulance crew member was monitored, and deemed to be clean and released.A survey of the ambulance by the IEMA MRT indicated no contamination due to the protective sheet covering prior to the patient entering in the ambulance.

The IEMA MRT removed the sheets and bagged them for later transfer to the appropriate receiving agency. Other areas of the ambulance were monitored and found clean. Through interview, decontamination procedures were reviewed with the IEMA MRT and ambulance crew. The steps the IEMA MRT described would have adequately decontaminated the ambulance.

Further discussions indicated the ambulance and ambulance equipment would have been adequately monitored for contamination, and released back to service.Through interview, the ambulance crew stated they would be directed by the MRT where to go for decontamination in the event that service was needed. They were familiar with the hazards of radiation contamination and the precautions to take to avoid the spread of contamination.

The JEMA MRT demonstrated the process of surveying the Riverside Medical Center receiving area with the Ludlum 2241-3 survey meter. He demonstrated and described what actions would be taken should contamination be found in this area. The IEMA MRT stated that an established 21 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station priority for getting the ambulance and the hospital's receiving area cleared and completed the radiation monitoring process to ensure that the ambulance and hospital receiving area were 3 placed back into service. All areas of the hospital and path from ambulance to treatment room were cleared and had readings of low background.

3 During the entire demonstration, the IEMA MRT continued to be aware of potentially contaminated areas, and conducted contamination surveys when contamination was suspected.

All activities described in the demonstration criterion were carried out in accordance with the plan, procedures and the extent-of-play agreement.

In summary, the status of DHS/FEMA criteria for this location is as follows: a. MET: 1.d.1, 1.e.1, 6.d. 1.b. AREAS REQUIRING CORRECTIVE ACTION: None c. DEFICIENCY:

None d. PLAN ISSUES: None e. NOT DEMONSTRATED:

None f. PRIOR ISSUES -RESOLVED:

None 3 g. PRIOR ISSUES -UNRESOLVED:

None 3.3.1.2 State of Illinois -Riverside Medical Center -Medical Service -Facility I Criterion 1.d.1: I As part of the Braidwood Station Radiological Emergency Preparedness Exercise on September 23, 2011, Riverside Medical Center demonstrated the use of at least two means of conmunication with appropriate locations for evacuee monitoring and decontamination in accordance with plans and procedures.

The demonstration was conducted during, an out-of-sequence activity at the Riverside Medical Center, 650 North Wall Street, Kankakee, Illinois, I from approximately 0900 hours0.0104 days <br />0.25 hours <br />0.00149 weeks <br />3.4245e-4 months <br /> to 1110 hours0.0128 days <br />0.308 hours <br />0.00184 weeks <br />4.22355e-4 months <br />.I At 1007 hours0.0117 days <br />0.28 hours <br />0.00167 weeks <br />3.831635e-4 months <br />, Riverside Medical Center Emergency Operations Coordinator received a call on the telephone from the Riverside Ambulance Service regarding a contaminated patient being transported to the emergency room. The Riverside Medical Center Emergency Department (ED)communications station contained a Medical Emergency Radio Communications of Illinois (MERCI) 800 MHz channel radio system, commercial cell phone, commercial landline telephone and a facsimile machine capability.

Internally, there is a public address and paging 22 I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station system that can be activated for this station. The cell phone system would be the first back-up communication system between the ambulance service and the center.The ambulance and the medical center utilized the MERCI radio system for initial and follow-up contact. Commercial landlines were in use within the ED during the drill. There were no communications equipment checks necessary since these systems were in continuous use during real world emergencies.

There were no communication failures noted during the exercise.All activities described in the demonstration criterion were carried out in accordance with the plan, procedures and extent-of-play agreement.

Criterion 1.e.1: As part of the Braidwood Station Radiological Emergency Preparedness Exercise on September 23, 2011, Riverside Medical Center demonstrated adequate equipment and supplies to support evacuee monitoring and decontamination in accordance with plans and procedures.

The demonstration was conducted during an out-of sequence activity at the Riverside Medical Center, 650 North Wall Street, Kankakee, Illinois, from approximately 0900 hours0.0104 days <br />0.25 hours <br />0.00149 weeks <br />3.4245e-4 months <br /> to 1110 hours0.0128 days <br />0.308 hours <br />0.00184 weeks <br />4.22355e-4 months <br />.The Radiological Emergency Area (REA) was in an area at the Hospital Emergency Room (ER), and used the ambulance entrance for outside access. Displays on one wall in the REA included two charts, one labeled "Radiation Emergency Response" and a "chart to identify patient contamination".

A poster sized checklist was attached to the wall inside of the treatment room used for the contaminated patient. The checklist was actively used by the buffer zone nurse to ensure activities were accomplished.

This checklist was also used by the MD Radiological staff to obtain telephone numbers for IEMA and REAC/TS to gain assistance/information.

The REA was taped off to identify the area. A floor mat was at the entrance and exit of the REA indicated that personal protective equipment (PPE) clothing must be removed before stepping on the floor mat to exit the REA.Radiation monitoring equipment available during the exercise consisted of a Model 14C Biodex calibrated July 8, 2011 and due for calibration on July 8, 2012 and had a pancake probe wrapped in a rubber glove for contamination control. The Biodex 14C was operationally checked and sourced checked in accordance with the operations manual.23 Unclassified 3 Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station 3 The secure parking area for the ambulance was successfully established by the security staff utilizing traffic cones and plastic barrier tape. 3 The Emergency Department treatment room was equipped with the necessary support materials and equipment.

This included PPE (face/eye shields, anti-contamination gowns, booties, gloves, hair covers); medical supplies (dressings, bandages, patient gowns, blood pressure monitors, stethoscopes, sterilized water, lab sample kits, etc.) and hazardous material handling equipment (hazardous waste containers with liners, sealable plastic bags, floor coverings, etc.). All items were in sufficient quantities to support several patients and staff. There were no shortages related to equipment or supplies during the exercise.

Those items needed that were not within the treatment room could be made available quickly from within the ER.The hospital plan provides several forms/checklists to be used by the ED staff during a radiological event. The form (Attachment II, ED buffer, Patient Decontamination Documentation Sheet) for recording CMP readings was utilized by the attending team.All REA staff were issue Arrow Tech Model 138 0-200 mR Direct-Reading Dosimeters (DRDs).The DRDs reviewed were within calibration dates. Issuance of and zeroing of the DRDs was not observed.All activities described in the demonstration criterion were carried out in accordance with the plan, procedures and extent-of-play agreement.

Criterion 3.a.1: As part of the Braidwood Station Radiological Emergency Preparedness Exercise on September 23, 2011, Riverside Medical Center demonstrated the ability to issue appropriate dosimetry and procedures and manage radiological exposure to emergency workers in accordance with the plans and procedures.

Emergency workers read their dosimeters periodically and at the end of each mission. The demonstration was conducted during an out-of-sequence activity on September 23, 2011, from approximately 0900 hours0.0104 days <br />0.25 hours <br />0.00149 weeks <br />3.4245e-4 months <br /> to 1110 hours0.0128 days <br />0.308 hours <br />0.00184 weeks <br />4.22355e-4 months <br />, at the Riverside Medical Center, 650 North Wall Street Kankakee, Illinois.In accordance with the hospital plans, the medical staff were issued dosimetry for this drill. Per the extent-of-play agreement, the medical staff did not demonstrate the use of dosimetry.

The Medical Center's internal management of radiological exposure control measures are addressed 24 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/I mprovement Plan Braidwood Station in the narrative to criterion 6.d. 1.All activities described in the demonstration criterion were carried out in accordance with the plan, procedures and extent-of-play agreement.

Criterion 6.d.1: As part of the Braidwood Station Radiological Emergency Preparedness Exercise on September 23, 2011, Riverside Medical Center demonstrated it had the appropriate space, adequate resources, and trained personnel to provide transport, monitoring, decontamination, and medical services to contaminated injured individuals.

The demonstration was conducted during an out-of-sequence activity at the Riverside Medical Center, 650 North Wall Street, Kankakee, Illinois, from approximately 0900 hours0.0104 days <br />0.25 hours <br />0.00149 weeks <br />3.4245e-4 months <br /> to 1110 hours0.0128 days <br />0.308 hours <br />0.00184 weeks <br />4.22355e-4 months <br />.The Riverside Medical Center staff were notified of the situation through a controller inject that was provided to the EMS of the Riverside Ambulance service. At 0930 hours0.0108 days <br />0.258 hours <br />0.00154 weeks <br />3.53865e-4 months <br />, a controller inject was given as a call for the Riverside Medical Center Emergency Department (ED) that an ambulance was being dispatched to pick-up an injured and possibly contaminated patient from the reception center. The ED Charge Nurse that received the message contacted the medical center staff. The ED nurse advised the staff of the available information and the likelihood that a contaminated patient Would be arriving at the ED.The drill scenario involved an accidental injury occurring within the 10-mile Emergency Planning Zone after a contamination release from the Braidwood Station. The Medical Center was notified that it would be the recipient of a possibly contaminated patient. The emergency alert sirens had sounded, and the public had been directed to evacuate affected areas and to report to reception centers set up in the local area. The scenario was based on a local resident who worked in the Braidwood Station Emergency Planning Zone and experienced a flat tire while driving to Kankakee Community College Reception Center. While loading the flat tire in the trunk, he lost his footing and fell where a broken bottle was laying, which embedded glass in his right hand. Upon arrival to the reception center, the portal monitor is tripped where IEMA staff notice he had an injury and was bleeding.

The IEMA staff called 911 and informed the reception center supervisor and the EMS dispatch notified the hospital.This notice initiated the medical center's response to prepare the ED for a Radiological event.Through discussion, the hospital would have mobilized staff by announcing a Code Radiation 25 Unclassified I Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station 3 over the Public Address system.The communications station within the ED contained sufficient radio and telephonic equipment to allow for the center to communicate with responding ambulance services.

3 The radio system utilized was the Medical Emergency Radio Communications of Illinois (MERCI) 800 MHz channel. During the drill, the ambulance and the medical center utilized the 800 MHz radio system for initial contact. Within the medical center, the public address system would be utilized to inform or provide messages to staff and occupants of the medical center. 3 However, the public address system was not used; the staff was assembled outside of the ED and briefed by the nurse that took the radio dispatch call. 3 The nurse advised the assembled staff of the contaminated injured patient and inbound status.The staff began immediate preparation for a radiological response.

I The Radiological Emergency Area (REA) was in an area at the hospital emergency room (ER), and used the ambulance entrance for outside access. The displays on one wall in the REA included two charts, one labeled "Radiation Emergency Response" and a chart to identify patient contamination.

The poster sized checklist was attached to the wall inside of the treatment room used for the contaminated patient. The checklist was actively used by the buffer zone nurse to ensure activities were accomplished.

This poster was also used by the MD Radiological staff to I obtain telephone numbers for IEMA and REAC/TS to gain assistance/information.

The REA was taped off to identify the area. A floor mat was at the entrance and exit of the REA indicated that PPE clothing must be removed before stepping on the floor mat to exit the REA.Radiation monitoring equipment available during the exercise consisted of a Model 14C Biodex calibrated July 8, 2011 and due for calibration on July 8, 2012 and an had a pancake probe wrapped in a rubber glove for contamination control. The Biodex 14C was operationally checked and sourced checked in accordance with the operations manual.I The secure parking area for the ambulance was successfully established by the security staff utilizing traffic cones and plastic barrier tape. I The Riverside Medical Center ED personnel followed their procedures and established a secure treatment room for the receipt of a contaminated injured patient. Medical center personnel 26 1 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station responding for drill activities included personnel from security, housekeeping, maintenance, radiology department, the radiation safety officer (RSO), and ED (nursing supervisor, physician, buffer zone nurse, and ancillary personnel.)

The hospital radiological decontamination team was available and was, prepared to conduct patient monitoring and decontamination.

The Riverside Medical Center personnel readied the treatment room for the patient's arrival. The driveway 'to the ED and the treatment room provided an area that could be controlled with minimal need for security personnel and traffic barriers.

During the exercise, yellow caution tape was strung across the driveway as a visual barrier to control/limit vehicle traffic. Physical security for the driveway and the ED entrance was controlled by medical center staff. The ambulance off loading area was protected from the weather by a fixed overhead canopy.There are two entrances to the ED, the main entrance under the overhead canopy and a triage entrance.

The main entrance into the Medical Center was through double electronically controlled doors. Inside the doors to the right was a short corridor with roll carts containing equipment/supplies.

The decontamination showers were located at the end of the corridor.

The main entrance electronic doorway was used for the receipt of the contaminated injured patient.Also inside the double electronically controlled doors, moving straight ahead, was another set of electronically controlled doors that opened up into the main ED. This interior doorway was taped off to prevent unauthorized personnel from accessing the buffer zone. Upon entering from the ambulance area through the exterior electronic doors the treatment room was the first room to the left. Once the patient was within the treatment room the doorway was taped off; establishing the buffer zone boundary area between the two electronically controlled entrances.

At 1000 hours0.0116 days <br />0.278 hours <br />0.00165 weeks <br />3.805e-4 months <br />, the Radiation Safety Officer (RSO) arrived at the treatment room to provide monitoring and technical support to Medical Center personnel.

The RSO surveyed the treatment room being used for the contaminated injured patient treatment and established a radiological baseline of 30 cpm. He arrived with a survey meter Biodex Model 14C Survey with a pancake probe attached, last calibrated on July 8, 2011 and personnel dosimetry.

The head of the pancake probe was covered with a surgical glove prior to the onset of the drill as identified in the Medical Centers response procedures; however it was removed after the initial patient survey.The RSO advised the attending staff within the treatment room that nothing was to leave the room without first being surveyed for contamination.

All supplies needed to set up the treatment 27 Unclassified 1 Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station room and perform decontamination activities were stored on carts in the room or in the adjacent corridor.

Yellow Caution tape and signs were obtained from one of the carts and used to visually establish control boundaries.

Receptacles were available, placed in strategic locations, and identified for contaminated waste. Medical and decontamination supplies located within the treatment room were of sufficient quantities.

Additional medical supplies and decontamination kits with cleaning supplies, wipes, and protective clothing were located in a supply cart in the receiving area just outside of the treatment room.In preparation to treat a contaminated patient, Medical Center ED personnel assisted each other as they each donned PPE which included a gown, two pairs of gloves, face masks, booties, and hair cover. Other available equipment included the necessary supplies for patient decontamination:

soap, moist wipes, sterile water, wraps in various sizes, and plastic bags to hold contaminated items. Individual packets with protective clothing were available for emergency response personnel.

According to the extent-of-play agreement the RSO's and ED staff had DRDs, Arrow Tech Model 138, 0-200 mR, but was not evaluated for the exercise.At 1007 hours0.0117 days <br />0.28 hours <br />0.00167 weeks <br />3.831635e-4 months <br />, a second radio call was received by the medical center from the Riverside Ambulance stating that they had arrived on scene. Vital signs and the patient's physical condition (injury to right hand) were transmitted to the nurse taking the call. All information received was recorded on a Riverside Emergency Department Radio Log. The log was delivered to the buffer zone nurse, who in turn briefed the awaiting treatment room staff. An estimated time of arrival of five minutes was briefed.I As the treatment room was readied for patient arrival, a gurney in the treatment room was covered with two sheets. A step-off pad was taped to the hallway floor in the buffer zone just outside each of the doorway entrance of the treatment room. The glass door to the ED remained I closed until the patient was prepared to depart the treatment room.During the drill, the buffer zone nurse stood on the outside of the treatment room interior doorway to control movement of persons and supplies into and out of the room. A strip of yellow caution tape was secured across the doorway to assist in identifying the buffer zone from the dirty zone. The nurse recorded medical and radiation survey information gathered during patient treatment.

The prescribed forms were used as directed by the Riverside Medical Center's 28 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station response plan.At 1012 hours0.0117 days <br />0.281 hours <br />0.00167 weeks <br />3.85066e-4 months <br />, the ambulance arrived at the medical center. The ambulance pulled into the secure area and up to the electronic double doors and the patient was unloaded from the ambulance.

Patient transfer occurred inside the established vehicle corridor then moved into the treatment room. The patient was double wrapped in sheets to prevent the spread of contamination.

The clean medical center gurney was placed next to the ambulance gurney and the patient was transferred.

Care was taken by medical center and ambulance personnel during patient transfer so as not to spread contamination.

The contamination reported was the left forehead temple region of 400 cpm; left hand 1800 cpm;right hand 1600 cpm; left foot 580 cpm; right foot 600 cpm, the hands and feet were covered with booties. Once transferred, a quick assessment of the patient's medical condition was conducted to determine if the injuries were life threatening.

The IEMA representative verbally provided the patient's condition to the attending Medical Center staff. He included in the patient pass down that the patient was contaminated and thepatient's injuries were not considered life threatening.

The patient was rolled into the treatment room with the medical team accompanying the patient.The buffer zone nurse staffed a station just outside of the treatment room in the clean entryway.After the patient was moved into the treatment room, the corridor was monitored to ensure that the area was clean for receiving additional patients, if needed, or clean for persons exiting the treatment room.The RSO announced to the attending staff that nothing was to leave the treatment room without being monitored for contamination.

The medical staff unwrapped the patient using a proper technique to contain any contamination.

Oncethe patient was unwrapped the staff noted that the patient's clothing had been cut away and the shoes removed. A physical assessment of the patient's injuries and medical condition were conducted.

Priority was given to ensuring that the patient was medically stable and the injury was treated prior to treatment for the exposure to radiation.

The attending physician directed that the vital signs be taken and questioned the patient on his injury and pain level. An attending nurse also questioned the patient for his identity and what had occurred at the accident site. All vital information was recorded by the buffer zone nurse.29 Unclassified 1 Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station I At 1020 hours0.0118 days <br />0.283 hours <br />0.00169 weeks <br />3.8811e-4 months <br />, after confirming that the patient did not have life threatening injuries, the RSO began surveying the patient for contamination.

The patient's survey information indicated that the contamination readings above the established baseline were detected at the left forehead, left palm, right palm, and left and right feet. 3 At 1023 hours0.0118 days <br />0.284 hours <br />0.00169 weeks <br />3.892515e-4 months <br />, the physician directed that samples be taken from the patient's nose and mouth to determine any possible ingestion of contaminated particles.

An attending nurse complied with the request. The first nasal swab sample taken from the nostril was placed in a sample container and sealed in a plastic bag, double bagged, and taken to the buffer zone nurse. The RSO 3 monitored the sample for contamination and reported background.

The buffer zone nurse accepted the sample into a second sealable plastic bag. A second sample of the mouth was taken and processed, by placing the sample into a sample container, bagged, surveyed, double bagged, and transferred out of the room.The following radiation readings were encountered and recorded:

Forehead at hairline 400 cpm;right palm 1600 cpm; left palm 1800 cpm; right foot 600 cpm; left foot 580 cpm. As the right 3 forearm was assessed, the injury site was viewed and the patient questioned for the location and level of pain. There was no visible break or dislocation of the limb. There was a visible lacerations and piece of glass in the wound. The patient complained moderate pain.The physician directed an attending nurse to administer a pain medication.

The RSO surveyed I the hands of the attending medical staff after the examination of the patient. Contaminated gloves were removed and bagged. The REA staff changed to new gloves frequently.

3 After the medical assessment was conducted, the RSO initiated actions to decontaminate the patient. The left forehead was cleaned with a swipe, and then read background.

The wound was unwrapped and glass removed by the physician.

The wound was irrigated I several times. After the last washing, the contaminated towel was disposed of in a hazardous waste container.

A clean towel was picked and the nurse began drying the forearm prior to her 3 changing her outer gloves. The RSO had surveyed the forearm prior to the drying and determined the arm to be under baseline (clean). The drying towel and contaminated gloves were 3 placed into a contamination bin.The hands of the patient were uncovered monitored and swiped until the readings were less than I 30 I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station two times background.

The nurses conducting the contamination removal disposed of waste properly in a hazardous waste container and changed gloves often. The contaminated areas were swiped as a means of decontamination.

The booties on the feet of the patient were removed and RSO read background after monitoring each foot.Throughout the Riverside Medical Center portion of the drill, the monitoring techniques used were slow and methodical, with proper positioning of the probe for personnel monitoring.

The RSO and staff effectively decontaminated all areas.As monitoring occurred, contamination readings found on the patient were verbally given to the buffer zone nurse, who recorded the information.

The prescribed forms for the decontamination recording were utilized as directed in the Medical Center's Code -Radiation policy.At 1037 hours0.012 days <br />0.288 hours <br />0.00171 weeks <br />3.945785e-4 months <br />, the patient was ambulatory and was directed to stand. The physician having determined that all immediate medical treatment was conducted and the decontamination was successful, he directed that a final survey of the patient be conducted.

Upon completion of the survey the patient could depart the secure room for further processing.

The RSO had the patient stand as he performed a complete survey of the patient. A clean pathway from the gurney to the glass door entrance was established by placing clean sheets on the floor. This survey process was carried out slowly and methodically as the medical staff and the RSO wanted to ensure that no contamination was overlooked.

The patient was determined to be clean and was guided to the doorway and seated in a wheelchair outside of the treatment room. The backside of the patient was also surveyed.

The removed materials were secured in a hazardous waste container within the treatment room.All supplies used during treatment were properly disposed of in a container.

As a precautionary measure, the injury site was re-surveyed to ensure that it had not become contaminated.

periodically during the decontamination process, attending staff would change their outer gloves to prevent the spread of contamination.

For demonstration purposes, the RSO performed a survey of the nurse as she exited the treatment room. The nurse started out by removing the outer gloves on both hands, rolling the inside of the glove to the outside during removal and then putting the gloves into a hazardous waste container.

The hands were surveyed and found clean.31 Unclassified 1 Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station The face mask and hair covering were removed. The nurse removed her gown; rolling the inside to the outside, and put the gown in the hazardous material container.

The RSO performed a slow and methodical full body survey. This was the same technique used for all survey conducted during the drill. The physician faced to exit the treatment room. The RSO surveyed the upper portion of the doorway to determine a clean area for the physician to have a handhold while the booties were removed and shoes were surveyed.

The RSO instructed the physician to remove the left bootie. After this occurred, the physician's left foot was surveyed.

It was found clean and he stepped out of the treatment room onto a clean step-off pad. This process was repeated with the other foot. Finally, the physician was told to take off the final pair of gloves. These were also placed into the hazardous waste container.

The RSO was interviewed regarding the clearing of the treatment room. He stated that he would follow the same procedures to clear and release the rest of the medical team from the room. All hazardous wastes would be double bagged, labeled, sealed and properly processed for disposal.Afterwards, he would survey the entire room for contamination, paying attention to the door jam and used equipment (gurney, backboard, scissors, stethoscope, etc). If contamination was found at any spot, a surface wipe would be done at the location and the area would be resurveyed.

If an area could not be decontaminated, the room would be closed off until more thorough decontamination efforts could be performed.

The RSO would provide direction on waste disposal that would be provided to him from State officials.

The RSO was interviewed to determine what action would be taken if there was a need to obtain technical assistance with the handling of radioactive contamination and contaminated patient care. He advised that if IEMA and State Radiological Emergency Assistance Center (REAC)could not be reached to provide the information that the Radiological Emergency Assistance Center/Training Site (REAC/TS) located in Oak Ridge, Tennessee, would be contacted.

The contact information these agencies was identified as being available on the Radiation Patient Treatment checklist/poster located on the wall outside of the treatment room.All activities described in the demonstration criterion were carried out in accordance with the plan, procedures and extent-of-play agreement.

In summary, the status of DHS/FEMA criteria for this location is as follows: a. MET: l.d.1,.l.e.l,3.a.l,6.d.l.

32 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station b. AREAS REQUIRING CORRECTIVE ACTION: None c. DEFICIENCY:

None d. PLAN ISSUES: None e. NOT DEMONSTRATED:

None f. PRIOR ISSUES -RESOLVED:

None g. PRIOR ISSUES -UNRESOLVED:

None 33 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station SECTION 4: CONCLUSION There were no Deficiencies, ARCAs, or Plan Issues identified for the State of Illinois.34

.Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station APPENDIX A: DRILL EVALUATORS AND TEAM LEADERS DATE: 2011-09-23, SITE: Braidwood Station, IL LOCATION AGENCY State of Illinois -Riverside Medical Center -Medical Service -Carolyn Sturghill FEMA RV Transportation State of Illinois -Riverside Medical Center -Medical Service -Delwyn Kinsley FEMA RV Facility____

.... ' :':J:* T am Le der ': 35 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station APPENDIX B: EXERCISE PLAN I 36 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station OFFSITE MEDICAL DRILL Riverside Medical Center (Reception Center)Kankakee, ILLINOIS September 23, 2011 10:00 a.m.37 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station EXTENT OF PLAY AGREEMENT FOR THE MEDICAL SERVICES EXERCISE September 23, 2011 Location: Riverside Medical Center Transportation Provider:

Riverside Ambulance 650 North Wall Street Kankakee, IL 60901 Participants:

Victim (volunteer)

Lead Controller: (IEMA)IEMA ER Monitor: Rick Zuffa IEMA Ambulance Monitor: IEMA Staff IEMA Hospital Controller Kathy Allen IEMA Ambulance Controller:

Joni Estabrook Criteria that can be re-demonstrated immediately for credit, at the discretion of the evaluator, include the following:

For Transportation:

1.d.1, 3.a.1 and 6.d.1; for the Hospital, 1.d.1, 1.e.1, 3.a.1 and 6.d.1. Criteria may be re-demonstrated, as agreed by the Lead Controller and FEMA Evaluators.

EVALUATION AREA 1 -EMERGENCY OPERATIONS MANAGEMENT Criterion 1.d.1: At least two communication systems are available, at least one operates properly, and communication links are established and maintained with appropriate locations.

Communications capabilities are managed in support of emergency operations.

The Riverside Ambulance will use 2-way radios to communicate with OSF St. James.Other communication systems that can be used include commercial telephone or cell phones.Criterion 1.e.1: Equipment, maps, displays, dosimetry, potassium iodide (KI) and other supplies are sufficient to support emergency operations.

OSF St. James will adequately demonstrate the ability to support operations, with adequate resources.

The availability of dosimetry and KI for hospital personnel will not be demonstrated during this exercise, however IEMA staff will be issued dosimetry and KI as field team members.38 I I I I I I I I I I I I I I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station EVALUATION AREA 3 -PROTECTIVE ACTION IMPLEMENTATION Criterion 3.a.1: The OROs issue appropriate dosimetry and procedures, and manage radiological exposure to emergency workers in accordance with the plan and procedures.

Emergency workers periodically and at the end of each mission read their dosimeters and record the readings on the appropriate exposure record or chart.The use of dosimetry and KI will not be demonstrated by hospital staff. IEMA staff will demonstrate appropriate use of dosimetry and KI.For purposes of the exercise, if there is no medical need to bring equipment into and out of the treatment room, nasal swabs will be taken (swabs to be taken outside the nose to simulate taking swabs inside the nose) and passed out of the room to demonstrate movement of equipment and supplies into and out of the controlled area. These swabs will also be utilized to establish if any radioactive materials have been inhaled.EVALUATION AREA 6.d -TRANSPORTATION AND TREATMENT OF CONTAMINATED INJURED INDIVIDUALS Criterion 6.d.1: The facility/ORO has the appropriate space, adequate resources, and trained personnel to provide transport, monitoring, decontamination, and medical services to contaminated injured individuals.

Riverside Ambulance will demonstrate the capability to transport contaminated, injured individuals to Riverside Medical Center. The ambulance crew will pick up a contaminated injured patient near the grounds of Riverside Medical Center. The ambulance crew will be aware that a release has occurred from Braidwood plant but not able to determine if the patient is contaminated.

Riverside Ambulance will utilize universal precautions and good housekeeping practices to minimize the spread of contamination, and will focus on treating the patient's medical condition.

Riverside Ambulance will call in the information regarding the patient to Riverside Medical Center in Kankakee so they can prepare for receipt of a potentially contaminated patient Riverside Medical Center will implement their plan for receipt, isolation and treatment of an injured contaminated patient. Medical personnel will utilize universal precautions and good housekeeping practices to minimize the spread of contamination, and will focus on treating the patient's medical condition.

Simple decontamination efforts will be demonstrated after the patient has been medically stabilized.

The hospital will demonstrate procedures for limiting exposure to hospital staff, decontaminating a patient, and restricting access to the area where the patient is being treated and monitored.

Hospital personnel will demonstrate their knowledge of who to call beyond IEMA for assistance in Radiological Accidents, e.g., REAC/TS.39 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station For purposes of this exercise, an IEMA staff member will be dispatched to Riverside Medical Center with radiation detection and measurement equipment to survey out ambulance staff. The purpose of having an IEMA MRT available is to facilitate monitoring the ambulance and ambulance personnel so they are not kept out of service for an extended period of time.The drill will conclude with the hospital representative supervising the removal of protective clothing and surveying of the emergency room and hospital personnel.

IEMA will also advise on the proper procedure for release or disposal of contaminated material.Following the conclusion of the drill, a short critique will be held.40 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station APPENDIX C:

SUMMARY

AND INJECTS OFFSITE MEDICAL DRILL (Summary and Injects)Riverside Medical Center Kankakee, IL September 23, 2011 Start time: 10:00 a.m.41 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station OBJECTIVES:

1. Demonstrate the ability of EMS personnel to transport a contaminated accident patient.2. Demonstrate the ability of hospital personnel to treat a contaminated injured patient.3. Demonstrate the ability of personnel to exercise proper radiological controls.4. Demonstrate the proper techniques of personnel decontamination.

5. Demonstrate good communication between medical personnel and IEMA staff.6. Demonstrate proper use of radiation detectors.

IEMA PLAYERS AND CONTROLLERS I I U I I I I I I Injured Victim IEMA Rad Monitor (Amb.)IEMA Rad Monitor (Hosp.)IEMA Ambulance Controller IEMA Hospital Controller Lead Controller TBD TBD Rick Zuffa Joni Estabrook Kathy Allen IEMA 42 I I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station EXTENT OF PLAY FOR RIVERSIDE MEDICAL DRILL INTRODUCTION:

An offsite medical drill will be conducted to demonstrate the State of Illinois' concept of operations for handling contaminated injured individuals.

The drill is structured to address MS-1 Hospital and Transportation criteria.NOTE: Evaluators should be aware that while hospital personnel are encouraged to assume responsibility for monitoring, decontamination, and contamination control activities within their facility to the extent they are able to do so, they are advised to take direction from Illinois Emergency Management Agency (IEMA) personnel regarding these issues. The purpose of providing IEMA support is to ensure appropriate radiation protection protocols are observed.Extent of Play: Braidwood Nuclear Power Station has declared a general emergency.

The emergency alert sirens have sounded, the public has been directed to evacuate affected areas and to report to reception centers set up in the local area. The scenario is based on a local resident who works in the Braidwood EPZ and experiences a flat tire while driving to Kankakee Community College. While loading the flat tire in the trunk she loses her footing and falls where a broken bottle was laying embedding glass in her right hand.Upon arrival to the reception center trips the portal monitor where IEMA staff notice she has injured herself and is bleeding.

IEMA calls 911 and informs the reception center supervisor.

1. An ambulance and EMS staff will be used to demonstrate loading, transporting and unloading the victim. EMS personnel will pick up the patient at a staged location close to the hospital.

IEMA staff will be present for the transportation portion of the drill.2. The ambulance crew will communicate with the receiving hospital regarding the medical status and any additional precautions taken to prevent spread of contamination.

3. IEMA MRT will be available to conduct monitoring at the simulated reception center and during transport.

4. IEMA MRT and hospital nuclear medicine staff will be providing radiological exposure control and monitoring of EMS and hospital personnel.

5. Decontamination is determinant on ambulance protocols and extent of the injury that the patient presents.43 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station I 6. The IEMA MRT will supervise the ingress and egress of radiological control areas. Monitoring will be performed prior to personnel leaving the potentially contaminated patient treatment area. Protective clothing used by i hospital personnel will be similar to that used for a chemical or biological agent in accordance with hospital protocol.7. Hospital nuclear medicine personnel will be the primary radiological advisor for contamination control and any patient and staff radiological monitoring and contamination control activities unless no nuclear medicine staff is I available to assume responsibility.

IEMA will be present to advise and assist as needed.8. The medical facility will demonstrate or describe their procedures for the medical treatment and necessary decontamination of a contaminated injured individual.

Multiple methods of decontamination, including dry, damp or wet, may be utilized for the removal of contamination.

IEMA/hospital nuclear medicine personnel will survey the hospital REA and medical personnel to maintain contamination control. These methods will I include taking swipes of floors and surfaces so that the hospital and ambulance can be cleared for normal operations.

9. The hospital may need to contact REAC/TS to determine appropriate samples needed to assess internal contamination.

Any samples collected will be sent to REAC/TS for analyzing, IEMA does not process biological samples.10. Emergency medical personnel will be able to maintain their exposure below 3 the limits specified in 10 CFR Part 20 because for the exercise, the dose rate from the patient is below 2 mr/hr.11. After the Hospital is notified, hospital personnel will prepare the area to receive the patient in accordance with their procedures and provide security as necessary.

IEMA as a general practice would, if necessary, post radiation signs in accordance with the requirements as set forth in 10 CFR Part 20. Hospital security will control the area in accordance with the same policies and procedures used to provide isolation in the treatment of a chemical or biological agent.I 44I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station 12. Regardless of specific written hospital procedures for addressing radiation contamination, the supervision and advice provided by IEMA personnel should be the governing guidance for determining whether the patient's contamination situation is appropriately addressed.

The drill shall terminate when the controller verifies that the criteria under Evaluation Area 6, Sub-element 6.d and Evaluation Area 3, Sub-element 3.a.1, have been satisfied.

NARRATIVE

SUMMARY

FOR IVCH MEDICAL DRILL Braidwood Nuclear Power Station has declared a general emergency.

The emergency alert sirens have sounded, the public has been directed to evacuate affected areas and to report to reception centers set up in the local area. The scenario is based on a local resident who was attempting to evacuate the EPZ. While evacuating the area she has a flat tire and injures her hand, which dramatically slows her leaving the area. She eventually reports to the local Reception Center.Upon arrival to the Reception Center the evacuee trips the portal monitor and is asked by IEMA staff to step aside for personal monitoring.

IEMA personnel notice the evacuee is bleeding and inquires regarding the person's injury. IEMA staff realizes the injury requires more than basic first aid and calls 911 and notifies the Reception Center Supervisor.

Riverside Ambulance is dispatched to the reception center to which an IEMA staff member accompanies the patient and ambulance crew.For purposes of the drill, a location close to the hospital will be used to represent the actual reception center. Ambulance personnel will demonstrate patient loading and transport.

Ambulance personnel will communicate with the receiving hospital.

Patient contact dose rates are less than 2 mR/hr. Contamination levels will be less than 5,000 cpm, which means EMS personnel are exempt from direct read dosimeters and LDs in accordance with IEMA procedures for personnel monitoring.

At the hospital an IEMA MRT will assist hospital staff in monitoring and decontamination efforts. For the purposes of the evaluated exercise, IEMA will provide two individuals to perform monitoring:

one will monitor ambulance and the other will provide assistance to hospital staff.45 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station U At the hospital, medical personnel will utilize universal precautions and good housekeeping practices to ensure contamination from the patient is controlled and not spread. Simple decontamination efforts will be demonstrated after the patient has been medically stabilized.

IEMA personnel will discuss the need to take additional samples for further radiological analysis.

Hospital personnel will demonstrate their knowledge of who to call beyond IEMA for assistance in Radiological Accidents, e.g., REAC/TS.For purposes of the exercise, if there is no medical need to bring equipment into and out of the treatment room, nasal swabs will be taken (swabs to be taken outside the nose to simulate taking swabs inside the nose) and passed out of the room to demonstrate movement of equipment and supplies into and out of the controlled area. These swabs will also be utilized to establish if any radioactive materials have been inhaled.The drill will conclude with the hospital representative and IEMA personnel supervising the removal of protective clothing and survey of the emergency room and hospital personnel.

IEMA will also advise on the proper procedure for release or disposal of contaminated material.

Following the conclusion of the drill, a short critique will be held.I I I I I I I I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station TIME: Pre t = 0 Victim Instructions MESSAGE FORM () Controller (X) Player ( ) Contingency Drill/Exercise Type: Riverside Medical Drill Message for: Victim and EMS staff MESSAGE The Braidwood Nuclear Station has issued a public broadcast that a radioactive release has occurred and that resident's and those working in your area are being evacuated.

You then report to the Reception Center.While driving you experience a flat tire. After changing it and putting the flat in your trunk you slip on gravel and fall into broken glass injuring your hand. Upon arrival at the reception center you trip the portalmonitor and are asked to step aside for personal monitoring.

IEMA staff notices you are bleeding and calls 911.You are in a moderate amount of pain from the glass cutting your arm and are having difficulty making a fist.You have no known medical issues other than a history of allergic reactions to penicillin.

FOR CONTROLLERS USE ONLY The information would be available to the hospital as they received preliminary notification information from outbound ambulance calls.47 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station TIME: Time 0 MESSAGE: Initial Conditions MESSAGE FORM (X) Controller (X) Player ( ) Contingency.

Drill/Exercise Type: Riverside Medical Drill Message for: Hospital Personnel MESSAGE Initial Conditions:

The patient initially is uncomfortable and slightly bleeding from embedded glass in her hand. T Contamination Initial survey First Second Third Decon Levels: Reading Decon Decon Right hand 1800 cpm 800 cpm 300 cpm 75 cpm Left hand 1600 cpm 600 cpm 60 cpm Backside of 1000 cpm 0 cpm Pants Pants should be removed'Pants at knees 800 cpm 0 cpm pants should be removed Hairline right 400 cpm temple Shoes (should 1200 cpm 0 should be removed) be removed*Pant/shoes should be removed and bagged.**Contamination would likely be spread from hand to injured arm either on patient's skin or clothing.Current Medical Conditions:

Current pain and bleeding of right arm.Note: See last page for contamination locations and levels.I I I I I I I I I I I FOR CONTROLLERS USE ONLY 48 I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station TO: First Responders/EMS FROM: EMS Controller NOTE: Do not provide the data to players unless the means to obtain it are demonstrated.

THIS IS A DRILL DO NOT initiate actions affecting safe operations Message: Patient pain is 7 of 10 and seems to be worsening.

EMS Arrival on Enroute to In REA After Treatment Scene Hospital Level of Alert & Alert & Alert & Alert &consciousness:

Oriented X3 Oriented X3 Oriented X3 Oriented X3 Respirations:

30 30 26 20 Pulse: 80 78 78 74 Skin: Normal Normal Normal Normal Pupils: PERL PERL PERL PERL Blood 120/70 116/62 116/62 135/78 Pressure: Bleeding and Bleeding and Bleeding and Bleeding and Visual: swelling of right swelling of right swelling of right swelling of right hand hand hand hand Note: ECG Monitor -Sinus tachycardia corresponding to pulse.Pulse Oximeter 97% on room air.* Penicillin Expected Action: Follow local protocols or standing orders.THIS IS A DRILL DO NOT initiate actions affecting safe operations 49 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station TIME: 0 + 5 min.MESSAGE: MESSAGE FORM (X) Controller (X) Player () Contingency Drill/Exercise Type: Riverside Medical Drill Message for: Hospital Personnel MESSAGE When Hospital is notified that a potentially contaminated patient will be arriving, the Hospital should make preparations to receive patient in accordance with hospital procedures.

IEMA staff will be dispatched to the hospital in advance of the receipt of the patient for purposes of this exercise.I I I I I I I I I I I FOR CONTROLLERS USE ONLY Issue the message only if ambulance departure from reception center was to occur after 1020. Realistically it would take 20 minutes after the initial call for the ambulance to respond and depart with the patient.50 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station TIME: After patient arrival at hospital MESSAGE: Decontamination Activities MESSAGE FORM (X) Controller 0 Player ( ) Contingency Drill/Exercise Type: Riverside Medical Drill Message for: IEMA RAD Controllers MESSAGE If proper radiological controls are in place no contamination is found in the ambulance.

All areas of the hospital and path from ambulance to treatment room will be surveyed and read as background.

The controller may adjust contamination levels based on actions of the players.The patient has contamination on right palm, left palm, forehead at hairline, right knee, left knee and on both pant cuffs and bottom and toes of shoes.IT DOES NOT MATTER IF THE CLOTHING IS REMOVED BY THE AMBULANCE OR HOSPITAL PERSONNEL.

Clothing should be bagged and labeled.FOR CONTROLLERS USE ONLY 51 Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station TIME: After patient arrival at hospital MESSAGE: Decontamination Activities MESSAGE FORM (X) Controller 0 Player ( ) Contingency Drill/Exercise Type: Riverside Medical Drill Message for: IEMA RAD Controller MESSAGE Decontamination efforts are as follows: Once clothing is carefully removed, all outer contamination is removed. Bagged clothing reads 1200 cpm.The first attempt will remove all contamination from the left palm, however the right palm will take several attempts.

After decontamination efforts the right hand still reads slightly above background but below the contamination threshold level.The temple at the hairline will not be able to be decontaminated on the first attempt and reads 400 cpm the second decon effort will result in readings slightly above background.

The contamination levels and locations may be adjusted accordingly.

The cuts and glass embedded in the patients hand should be properly addressed by hospital personnel as well as observing contamination control measures.*Pants and shoes should be removed and bagged.**Contamination would likely be spread from hand to injured arm either on patient's skin or clothing.Note: Controllers may adjust levels based on player actions.i I I I I I I I I FOR CONTROLLERS USE ONLY 52 I Unclassified Radiological Emergency Preparedness Program (REP)After Action Report/Improvement Plan Braidwood Station This page is intentionally blank.53