ML111320338

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Submittal of Arkansas Nuclear One Medical Services Final Exercise Report, Exercise Date - April 13, 2011
ML111320338
Person / Time
Site: Arkansas Nuclear  Entergy icon.png
Issue date: 05/09/2011
From: Lawrence Hammond
US Dept of Homeland Security, Federal Emergency Management Agency
To: Collins E
Region 4 Administrator
cecere, Bethany NSIR/DPR 415-6754
References
Download: ML111320338 (30)
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Text

Arkansas Nuclear One After Action Report/

Improvement Plan Drill Date - April 13, 2011 Radiological Emergency Preparedness (REP) Program Published May 09, 2011

Unclassified Radiological Emergency Preparedness Program (REP)

After Action Report/Improvement Plan Arkansas Nuclear One

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Unclassified Radiological Emergency Preparedness Program (REP)

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Arkansas Nuclear One After Action Report/Improvement Plan Published May 09, 2011 Contents Executive Summary 3 Section 1: Exercise Overview 4 1.1 Exercise Details 4 1.2 Exercise Planning Team Leadership 4 1.3 Participating Organizations 5 Section 2: Exercise Design Summary 7 2.1 Exercise Purpose and Design 7 2.2 Exercise Objectives, Capabilities and Activities 7 2.3 Scenario Summary 7 Section 3: Analysis of Capabilities 8 3.1 Drill Evaluation and Results 8 3.2 Summary Results of Drill Evaluation 8 3.3 Criteria Evaluation Summaries 11 3.3.1 Risk Jurisdictions 11 3.3.1.1 Pope County EMS - St. Mary's Station 11 3.3.2 Support Jurisdictions 11 3.3.2.1 University of Arkansas for Medical Sciences 11 Hospital Section 4: Conclusion 12 Appendix A: Best Practices 13 Appendix B: Drill Evaluators and Team Leaders 14 Appendix C: Acronyms and Abbreviations 15 Appendix D: Exercise Plan 16 1

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EXECUTIVE

SUMMARY

On April 12-13, 2011, an out-of-sequence ambulance drill conducted in Russellville, Arkansas for the Pope County Emergency Medical Services (EMS) - St. Mary's Station followed by an out-of-sequence medical drill was conducted at the University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas. Personnel from the U.S. Departmentof Homeland Security/Federal Emergency Management Agency (DHS/FEMA) Region VI, evaluated all activities. The purpose of the drills was to assess the level of preparedness of local responders to react to a simulated radiological emergency at Arkansas Nuclear One (ANO). The previous UAMS medical drill at this site was conducted on April 14, 2009. The previous ambulance drill for Pope County EMS - St. Mary's Station was conducted on April 14, 2009.

Personnel from the Pope County EMS, University of Arkansas Medical Sciences, and Arkansas Nuclear One participated in the drills. Evaluation Areas demonstrated included: Equipment and Supplies to Support Operations, Implementation of Emergency Worker Exposure Control, and Support Operations/Facilities Transportation and Treatment of Contaminated Injured Individuals. Cooperation and teamwork of all participants was evident during these drills, and DHS/FEMA wishes to acknowledge these efforts.

This report contains the final evaluation of the out-of-sequence drills. The participants demonstrated knowledge of their emergency response plans and procedures and adequately demonstrated them. There were no Deficiencies and no ARCAs identified during the drills.

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Unclassified Radiological Emergency Preparedness Program (REP)

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SECTION 1: EXERCISE OVERVIEW 1.1 Exercise Details Exercise Name Arkansas Nuclear One Type of Exercise Drill Exercise Date April 13, 2011 Program Department of Homeland Security/FEMA Radiological Emergency Preparedness Program Scenario Type Radiological Emergency 1.2 Exercise Planning Team Leadership Lisa Hammond RAC Chair FEMA Region VI Technological Hazards Branch Chief 800 North Loop 288 Denton, Texas, 76209 940-898-5199 lisa.hammond@dhs.gov Timothy Pflieger Federal Planning Team Lead FEMA Region VI Technological Hazards Program Specialist 800 North Loop 288 4

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Denton, Texas, 76209 940-383-7325 timothy.pflieger@dhs.gov Don Greene State Planning Team Lead Arkansas Department of Health Emergency Planner 4815 West Markham Street Slot 30 Little Rock, Arkansas, 72205 501-661-2808 donald.greene@arkansas.gov Robert Fowler Utility Planning Team Lead Arkansas Nuclear One Senior Emergency Planner 1448 SR 333 Mail Stop N-ADM-14 Russellville, Arkansas, 72802 479-858-4993 RFOWLER@Entergy.com 1.3 Participating Organizations Agencies and organizations of the following jurisdictions participated in the Arkansas Nuclear One drill:

Risk Jurisdictions Pope County Emergency Medical Services Support Jurisdictions University of Arkansas for Medical Services Private Organizations 5

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Entergy Operations, Inc.

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SECTION 2: EXERCISE DESIGN

SUMMARY

2.1 Exercise Purpose and Design The DHS/FEMA Region VI Office evaluated the drill on April 12-13, 2011 to assess the capabilities of local emergency preparedness organizations in implementing their Radiological Emergency Response Plans and procedures to protect the public health and safety during a radiological emergency involving Arkansas Nuclear One (ANO). The purpose of this report is to present the results and findings on the performance of the offsite response organizations during a simulated radiological emergency.

2.2 Exercise Objectives, Capabilities and Activities Exercise objectives and identified Capabilities/REP Criteria selected to be exercised are discussed in the Exercise Plan (EXPLAN), Appendix D.

2.3 Scenario Summary The drill scenario was developed to evaluate the response of drill participants to an incident at Arkansas Nuclear One (ANO) requiring the transportation, treatment and decontamination of a radiologically contaminated injured individual. The drill scenario provided for the evaluation of the University of Arkansas for Medical Sciences (UAMS) and Pope County Emergency Medical Services (EMS) - St. Mary's Station.

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SECTION 3: ANALYSIS OF CAPABILITIES 3.1 Drill Evaluation and Results Contained in this section are the results and findings of the evaluation of all jurisdictions and functional entities, which participated in the April 12-13, 2011 ambulance and medical drills to test the offsite emergency response capabilities of local governments and support medical centers for Arkansas Nuclear One (ANO).

Each jurisdiction and functional entity was evaluated on the basis of its demonstration of criteria delineated in exercise evaluation area criteria contained in the Federal Register, Vol. 67, No. 80, "FEMA - Radiological Emergency Preparedness: Exercise Evaluation Methodology" (April 25, 2002) and the Interim REP Program Manual. Detailed information on the exercise evaluation area criteria and the extent-of-play agreement used in this exercise are found in Appendix D 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 evaluation area criteria from the REP Program Manual that were scheduled for demonstration during this exercise by all participating jurisdictions and functional entities. Exercise evaluation area criteria are listed by number and the demonstration status of those evaluation area criteria is indicated by the use of the following letters:

M - Met (No Deficiency or Areas Requiring Corrective Actions [ARCAs] assessed and no unresolved ARCAs from prior exercises)

D - Deficiency assessed A - ARCA(s) assessed or unresolved ARCA(s) from prior exercise(s)

N - Not Demonstrated P - Plan Issue 8

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Table 3.1 - Summary of Drill Evaluation Pope County EMS - St Mary's Station DATE: 2011-04-13 SITE: Arkansas Nuclear One, AR M: Met, A: ARCA, D: Deficiency, P: Plan Issue, N: Not Demonstrated UAMS Emergency Operations Management Mobilization 1a1 Facilities 1b1 Direction and Control 1c1 Communications Equipment 1d1 Equip & Supplies to support operations 1e1 M M Protective Action Decision Making Emergency Worker Exposure Control 2a1 Radiological Assessment and PARs 2b1 Decisions for the Plume Phase -PADs 2b2 PADs for protection of special populations 2c1 Rad Assessment and Decision making for the Ingestion Exposure Pathway 2d1 Rad Assessment and Decision making concerning Relocation, Reentry, and Return 2e1 Protective Action Implementation Implementation of emergency worker exposure control 3a1 M M Implementation of KI decision 3b1 Implementation of protective actions for special populations - EOCs 3c1 Implementation of protective actions for Schools 3c2 Implementation of traffic and access control 3d1 Impediments to evacuation are identified and resolved 3d2 Implementation of ingestion pathway decisions - availability/use of info 3e1 Materials for Ingestion Pathway PADs are available 3e2 Implementation of relocation, re-entry, and return decisions. 3f1 Field Measurement and Analysis Adequate Equipment for Plume Phase Field Measurements 4a1 Field Teams obtain sufficient information 4a2 Field Teams Manage Sample Collection Appropriately 4a3 Post plume phase field measurements and sampling 4b1 Laboratory operations 4c1 Emergency Notification and Public Info Activation of the prompt alert and notification system 5a1 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 5b1 Support Operations/Facilities Mon / decon of evacuees and emergency workers, and registration of evacuees 6a1 Mon / decon of emergency worker equipment 6b1 9

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Temporary care of evacuees 6c1 Transportation and treatment of contaminated injured individuals 6d1 M M 10

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3.3 Criteria Evaluation Summaries 3.3.1 Risk Jurisdictions 3.3.1.1 Pope County EMS - St. Mary's Station

a. MET: 1.e.1, 3.a.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
g. PRIOR ISSUES - UNRESOLVED: None 3.3.2 Support Jurisdictions 3.3.2.1 University of Arkansas for Medical Sciences Hospital
a. MET: 1.e.1, 3.a.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
g. PRIOR ISSUES - UNRESOLVED: None 11

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SECTION 4: CONCLUSION Based on the results of the drill, the offsite radiological emergency response plans and preparedness for the State of Arkansas and the affected local jurisdictions are deemed adequate to provide reasonable assurance that appropriate measures can be taken to protect the health and safety of the public in the event of a radiological emergency. Therefore, 44 CFR Part 350 approval of the offsite radiological emergency response plans and preparedness for the State of Arkansas site-specific to Arkansas Nuclear One will remain in effect.

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APPENDIX A: BEST PRACTICES

1. Marking inner glove with an X Summary: When donning personal protective equipment (PPE), University of Arkansas for Medical Sciences (UAMS) staff marked their inner pair of latex gloves with an "X" to denote that was the inner glove.

==

Description:==

UAMS staff performed numerous glove changes during operations. When the staff reached their inner gloves (marked with an "X"), the staff knew that extra outer gloves should be donned to aid in contamination control.

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APPENDIX B: DRILL EVALUATORS AND TEAM LEADERS DATE: 2011-04-13, SITE: Arkansas Nuclear One, AR LOCATION EVALUATOR AGENCY Pope County EMS - St. Mary's Station *Brad DeKorte DHS/FEMA University of Arkansas for Medical Sciences Hospital Brad DeKorte DHS/FEMA

  • Tim Pflieger DHS/FEMA
  • Team Leader 14

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APPENDIX C: ACRONYMS AND ABBREVIATIONS Acronym Meaning ADH Arkansas Department of Health ANO Arkansas Nuclear One ARCA Area Requiring Corrective Action BZ Buffer Zone CPM Counts Per Minute DHS/FEMA Department of Homeland Security/ Federal Emergency Mangement Agency DRD Direct Reading Dosimeter ED Emergency Department EMS Emergency Medical Services EMT Emergency Medical Technician EPZ Emergency Planning Zone KI Potassium Iodide ORO Off-site Response Organization OSL Optically Stimulated Luminescent PPE Personal Protective Equipment RAC Regional Assistance Committee REA Radiological Emergency Area REP Radiological Emergency Preparedness RPT Radiation Protection Technician RSO Radiation Safety Officer UAMS University of Arkansas for Medical Sciences 15

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APPENDIX D: EXERCISE PLAN 16

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Arkansas Nuclear One 2011 UAMS MS-1 Drill April 12-13, 2011 Extent-of-Play (EOP) Agreement Between The Arkansas Department of Healths Nuclear Planning and Response Program and FEMA Region VI EVALUATION AREA 1 Emergency Operations Management Sub-element 1.e - Equipment and Supplies to Support Operations INTENT This sub-element is derived from NUREG-0654, which provides that Offsite Response Organizations (ORO) have emergency equipment and supplies adequate to support the emergency response.

Criterion 1.e.1: Equipment, maps, displays, Dosimetry, potassium iodide (KI), and other supplies are sufficient to support emergency operations. (NUREG-0654, H.7, 10; J.10.a, b, e, J.11; K.3.a)

Locations: University of Arkansas for Medical Sciences (UAMS); Pope County EMS (St Marys Station), Russellville EOP: 1. It is Arkansas policy to issue KI only to Emergency Workers (EW) and institutionalized individuals in the 10-mile EPZ. .

2. Meters or DRDs that have bar code labels can have their calibration and operational check dates verified with the master database maintained by the NP&RP HP. Each meter will have a range sticker attached.
3. The quantities of Dosimetry and the quantities and expiration of KI will be confirmed by evaluators at locations identified in plans.
4. Meters that do not have bar code labels will have appropriate calibration stickers attached.

ARCA: None

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EVALUATION AREA 3 Protective Action Implementation Sub-element 3.a - Implementation of Emergency Worker Exposure Control INTENT This sub-element is derived from NUREG-0654, which provides that OROs should have the capability to provide for the following: distribution, use, collection, and processing of direct-reading Dosimetry and permanent record Dosimetry; the reading of direct-reading Dosimetry by emergency workers at appropriate frequencies; maintaining a radiation dose record for each emergency worker; and establishing a decision chain or authorization procedure for emergency workers to incur radiation exposures in excess of protective action guides, always applying the ALARA (As Low As is Reasonably Achievable) principle as appropriate.

Criterion 3.a.1: 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 exposure record or chart. (NUREG-0654, K.3.a,b)

Locations: University of Arkansas for Medical Sciences (UAMS); Pope County EMS (St Marys Station), Russellville EOP: 1. EMS crews will use gloves and booties as necessary. Hospital teams will wear anti-Cs IAW hospital plans.

2. Dosimetry and KI will be issued IAW plans.
3. The RO or designee will demonstrate the EW briefing, record keeping, and procedures for issuing and returning dosimetry and KI. The use of KI will be simulated.
4. Correction-on-the-spot will be considered at these locations at the discretion of and concurrence between the evaluator and the controller.

Caution should be exercised to ensure that exercise play is not interrupted.

ARCA: NONE

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Sub-element 6.d - Transportation and Treatment of Contaminated Injured Individuals INTENT This sub-element is derived from NUREG-0654, which provides that Offsite Response Organizations (ORO) should have the capability to transport contaminated injured individuals to medical facilities with the capability to provide medical services.

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. (NUREG-0654, F.2; H.10; K.5.a, b; L.1, 4)

Locations: Pope County EMS (St Marys Station), Russellville EOP: 1. The Controller will contact Pope County 911 with the exercise message.

Communication between the ambulance and the EMS dispatch will be demonstrated. EMS dispatch will discuss procedures for passing information to UAMS.

2. The EMS will pick up the patient at the plant. Prior to transfer of the patient, EMS and/or Entergy personnel will demonstrate monitoring the patient.

After patient transfer to the training center, the EMS will demonstrate vehicle monitoring. The ambulance will not be draped.

3. This EA will be demonstrated at approximately 1500 on April 12, 2011
4. Any real emergency will take precedence.
5. Correction-on-the-spot will be considered at these locations at the discretion of and concurrence between the evaluator and the controller.

Caution should be exercised to ensure that exercise ARCA: None Location: U of A for Medical Science (UAMS), Little Rock EOP: 1. This EA will be demonstrated at approximately 1000 on April 13, 2011

2. Any real emergency will take precedence.
3. The patient will be transported to UAMS via a non-emergency vehicle.
4. Radiation decontamination, monitoring and contamination control will be performed by both UAMS and Entergy personnel.
5. The ANO Controller will contact UAMS Emergency Room with the alerting message approximately one (1) hour prior to patient arrival
6. The ANO Controller will contact UAMS Emergency Room with an update message approximately fifteen (15) minutes prior to patient arrival
7. UAMS personnel will not take any action to prepare for the demonstration of these evaluation areas before the One (1) hour notification.

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8. No shift change will be performed. A list of second shift Key Personnel will be given to the evaluator.

st

9. The 1 shift may be over staffed for training purposes. Some staff nd st identified on the 2 shift roster may play with the 1 team. In an actual emergency this over staffing would not be used.

ARCA: None

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POPE COUNTY EMS/UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES FEMA EVALUATION MS-1 Emergency Medical Scenario April 12 and 13, 2011 SCENARIO:

A group of mechanics was replacing a Reactor Coolant Pump seal. In order to disassemble the seal it was attached by slings and shackles to the crane in the work area. As the lift began one of the shackles slipped, causing the load to shift. This shift, in turn, caused one sling to fail and the load dropped and swung out to the side striking one of the mechanics. As the seal plate swung by the mechanic, a metal flange attached to the seal plate ripped across and down the mechanics right thigh. Then the seal swung back and struck the mechanic knocking him to the floor.

The load was quickly lowered to the floor, and the other mechanics rushed to the downed mans side to provide assistance. The mechanics protective clothing was torn where the flange had struck his leg, and blood was oozing from the wound. One of the mechanics put his hand on the open wound, and the Control Room was notified that the Emergency Medical Team was needed.

The Emergency Medical Team initiated care of the patient by doing the following:

1. Establishing that the seal plate had been secured and the scene was safe.
2. Gained control of the patients cervical spine.
3. Placed gauze dressings in place to control bleeding.
4. Assessed the patients airway, breathing, and circulation.
5. Determined the patients level of consciousness.
6. Immediately began to cut away the patients anti-cs.
7. Cut away the patients greens to expose the leg.
8. Replaced the gauze with abdominal dressings to control bleeding and protect the wound from further contamination.
9. Requested an ambulance be dispatched.

The Emergency Medical Team established that:

1. The patient was conscious and complaining of pain to the right leg, and pain to the back of his head.
2. The patient was breathing without difficulty, and that he had Radial pulses and distal pulses in both feet.
3. The patient had received a jagged cut to the right thigh that started approximately three inches below the top of the thigh and extended laterally down across the leg.
4. Emergency Medical Team personnel also assumed that contamination would be present in the wound due to the equipment/material involved in the injury.

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Arkansas Nuclear One Plant Staff and Emergency Medical Team response:

Action: Finding/result

1. Checked scene safety. Scene safe.
2. Determined level of consciousness. Patient is alert and oriented.
3. Checked airway, breathing, Airway open, patient breathing without circulation. difficulty. Carotid and radial pulse present.
4. Assessed bleeding. Patient is bleeding from the right leg on the upper and lateral portion of the thigh.
5. Assessed injuries/cut away pants. Jagged laceration beginning just below the Removed shoe and sock. top of the thigh and extending laterally and downward toward the knee.
6. Performed quick head-to-toe Head survey.
  • No obvious injuries, but the patient complains of some pain to the back of the head.

Neck

  • No obvious injuries.
  • Complains of pain to the neck.

Chest

  • No obvious injuries.

Abdomen, lower back, pelvis

  • No obvious injuries.

Lower extremities

  • Right leg as previously noted/no other injuries noted.

Upper extremities

  • No obvious injuries.
7. Identifies potential cervical spine
  • Emergency Medical Team Scene Leader injury. requests ambulance.
  • Drill controller will make notifications to initiate ambulance response.
8. Changed from initial 4 X 4 gauze pads to Abdominal dressings.
9. Administered oxygen.
10. Packaged patient on Long Spine Board, with CID and c-collar.
11. Assessed vital signs.
  • Pulse-100 regular strong.
  • Respirations-28 unlabored.
  • Skin-Warm, flushed, moist.
  • B/P-132/84.

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Action: Finding/result

12. HP surveyed patient for
  • 20,000 ccpm on the right thigh, along the contamination. line of the wound.
  • 15,000 ccpm on the lateral portion of the right leg.
  • 10,000 ccpm around the knee and upper portion of the calf.
  • No other contamination found.
13. Transferred to stokes basket for transport to CA-1.
14. Arrived at CA-1. Medical staff assumes care of the patient.
15. Injuries and vital signs are re-
  • No new injuries noted.

assessed.

  • Pulse-90 regular strong.
  • Respirations-24 unlabored.
  • Skin-Warm, dry, normal color.
  • B/P-126/80.
16. Health Physics Technician surveys
  • 20,000 ccpm on the right thigh, along the for contamination. line of the wound.
  • 15,000 ccpm on the lateral portion of the right leg.
  • 10,000 ccpm around the knee and upper portion of the calf.
  • No other contamination found.
17. Discuss decontamination options.
  • Due to injuries, determine that it will be better for the patient to delay decontamination until the patient reaches the hospital.
18. Continue oxygen therapy Established IV Normal Saline.
19. Package patient for transport as
  • Move patient to clean LSB.

contaminated.

  • Place LSB in disposable body bag.
  • Close body bag around patient.
  • Leave bag open at about chin level.
20. Transfer patient to Pope County
  • Provide Paramedic with Patient EMS Paramedic. Information Form.
  • Give verbal description of injuries and care provided.
  • Introduce Paramedic to HP who will accompany the patient to hospital.
21. Pope County EMS receives
  • Re-route ambulance to UAMS in Little notification that St. Marys Hospital Rock.

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Action: Finding/result

22. Plant staff notifies UAMS that Pope
  • Drill Controller will make this call County EMS is transporting a approximately 1 hour1.157407e-5 days <br />2.777778e-4 hours <br />1.653439e-6 weeks <br />3.805e-7 months <br /> prior to contaminated patient to their scheduled drill start time.

Emergency Department.

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Pope County Emergency Medical Services: (on-scene/transport)

Expected Action: Finding/result

1. Receive patient information from
  • Patient Information Form.

Emergency Medical Team

  • Verbal description of injuries and care personnel. provided.
  • Introduce Paramedic to HP who will accompany the patient to hospital.
2. Confirm packaging and treatment

provided.

  • Patient packaged in body bag.
  • Wound covered with Abdominal dressing.
3. Provide receiving hospital with radio
  • See previous information.

report concerning the patient that is being transported.

4. Upon arrival at hospital, frisk the
  • No contamination noted outside of patient package and the ambulance patient containment bag.

for contamination.

5. Provide turnover to hospital staff.
  • See previous information.

NOTE: Failure to perform all of these actions does not indicate failure on the part of the participant.

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University of Arkansas for Medical Sciences Response Expected Action: Finding/result

1. Receive notification via telephone
  • Patient has a large laceration on the (drill controller) that a patient is right thigh, and possible neck and spine being brought from Arkansas injuries.

Nuclear One. (see #22 of ANO

  • The patient is contaminated.

Response.

2. Receive radio report from Pope
  • See Paramedic information received County EMS (provided by drill from ANO personnel.

controller approximately 15 minutes prior to arrival at UAMS).

3. Receive patient from Pope County
  • Patient Information Form Emergency Medical Services.
  • Verbal description of injuries and care provided.
4. Re-assess patients injuries.
  • Controller will provide information consistent with the scenario.
5. Provide care as needed based on
  • Controller will provide information assessment. consistent with the scenario/injuries noted.
6. Determine the extent of
  • 20,000 ccpm on the right thigh, along the contamination involved. line of the wound.
  • 15,000 ccpm on the lateral portion of the right leg.
  • 10,000 ccpm around the knee and upper portion of the calf.
  • No other contamination found.
7. Decontaminate patient.
  • For each decontamination attempt the amount of contamination will decrease as follows:
  • 1st attemptreduce contamination by 1/2.
  • 2nd attempt with the same methodno reduction in contamination.
  • 1st attempt with new methodreduce contamination by 1/2.
  • 2nd attempt with second methodno reduction in contamination.
  • Continue with other methods until observer indicates the objective has been satisfied.
  • Final survey of the patient shows 250 ccpm.
8. Hospital staff verbalizes continuing
  • Cover and protect wound, and move care of patient. patient to clean area of the hospital.

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