ML20097B944

Rev 2 to Salem Memorial Hosp Decontamination Plan

ML20097B944
Person / Time
Site:	Hope Creek
Issue date:	03/31/1984
From:	SALEM COUNTY MEMORIAL HOSP., SALEM, NJ
To:
Shared Package
ML20097B942	List: ML20097B939 ML20097B944
References
PROC-840331, NUDOCS 8409140201
Download: ML20097B944 (60)

Text

. . . - -. .. - . -. - . - . . - . - . . _- . .. -- _.. . . . . .

, Revision: 2

-j March,1984 e

• S

• O e

s DECONTANINATION AND TREATMENT r- 0F .. .

THE RADI0 ACTIVELY CONTAMINATED PATIENT 4

AT

• SALEM COUNTY HEMORIAL HOSPITAL ,

1 l .

. .pe i

a i

{

l 4

I l .

4 1

a -

1 e

, 4 -

KO F .

- l

l

. ',Rev i s ion : 3

, June, 1984 '

<- m

'('~' ) DECONTAMINATION AND TREATHENT 0F THE PADI0 ACTIVELY CONTAMINATED PATIENT '

AT -

SALEM COUNTY MEMORIAL HOSPITAL .

, TABLE OF CONTENTS

' TITLE PAGE NO. REV/DATE A. PURPOSE AND SUfMARY 1 3 6/84

8. PRECAUTIONS 1 '3 6/84 C. PREREQUISITES

~

. 1. Alert / Notification 2 '. 3 6/84

2. Prior Action at Salem Nuclear Generating 3. 2 3/84 Station D. LIMITATIONS AND ACTIONS 3 2 3/84 E. PROCEDURE l

. 1. Notification 3 3 6/84

_T 2. Nursing Supervisor's Duties (d

3.

4.

Maintenance / Housekeeping Personnel's Duties Emergency Room Nursing Personnel's Duties 4

5 3 6/84 3 6/84 6 3 6/84

5. Attending Physician's Duties 7 3 6/84

6. Control Pofrft' Attendant's Duties 8 3 6/84

7. Buffer Zone Attendant's Duties 9 3 6/84

8. President's Duties 10 2 3/84

9. Plant Radiation Protection Technician's (RPT) 11 3 6/84 Duties F. RETURN OF REA TO NORMAL USE 12 2 3/84 G. PATIENT TRANSFER TO DEFINITIVE CARE CENTER 12 2 3/84 H. PROCEDURE FOR HANDLING HULTIPLE VICTINS 12 3 6/84 l

lO i

e

. . . - - _ _ _ _ _ , , . . , _ . _ _ - , - . . , _ . . . , .,,,,-._..____,.,_,..__,___,_,_,.__..-,._,_,......,._,,,_..,__.,,,__._y,y., . _ _ , , ,,..._,.,_,r, -

Hevision: d June, 1984 ATTACHMENTS REV/DATE DIAGRAM I

-DIAGRAM II AMBULANCE ACCESS ROUTE TO REA 1 6/84 DIAGRAM III ATTENDANT GARB 3 6/84 DIAGRAM IV_ FLOOR COVERING FOR PATIENT TRANSFER 1 6/84 ATTACHMENT A PROCEDURE FOR HANDLING ANY RADIATION 3 6/84 ACCIDENT VICTIM

' ATTACHMENT B TELEPHONE PROCEDURE FOR RADIATION 3 6/84 ACCIDENT EMERGENCIES - NURSING SUPERVISOR ATTACHMENT C EMERGENCY TREATMENT OF RADIATION ACCIDENT 3 6/84 ATTACHMENT D PROCEDURE FOR THE USE OF PROTECTIVE CLOTHING 1 6/84~

AND DOSIMETERS ATTACHMENT E PROCEDURE FOR PATIENT DECONTAMINATION AND 3 6/84 *

-SAMPLE TAKING .

ATTACHMENT F PARTS LIST FOR DECONTAMINATION AND SAMPLE O 12/80

\ TAKING KITS ATTACHMENT G REA STORED SUPPLIES AND EQUIPMENT 3 6/84 ATTACHMENT H RADIATION EMERGENCY TELEPHONE DIRECTORY 5 6/84 ATTACHMENT I LOCATION OF MANUALS 5 8/84 ATTACHMENT J PERSONNEL DOSIMETRY LOG AND PATIENT DATA 0 12/82 SHEETS i

3 9

9

Revision: 3 June, 1984 DECONTANINATION & TREATMENT OF THE p RADI0 ACTIVELY CONTAMINATED PATIENT AT SALEM COUNTY MEMORIAL HOSPITAL

~

A. . PURPOSE AND SulMARY

1. By_ agreement between Public Service Electric & Gas Company and Salem

_- County Hemorial Hospital, personnel at Salem Nuclear Generating Station I

sustaining injuries' from ionizing radiation or injuries complicated by radiation exposure or radioactive contamination will be provided care and treatment at Salem County Memorial Hospital. '

2. .Most of these injury cases will present no hazard to,tospital hersonnel and will be admitted and provided care and treatment in accordance with

~

the hospital's operating procedures. However, in the event that an acci-dent victim is radioactively contaminated, he will be admitted, decon-taminated and treated in accordance with these procedures. .

3. '

The purpose of these procedures is to assure the radiation protection of the hospital staff, other patients and visitors during admission and treatment of, the radioactively contaminated patient. The hospital's protection pcogram starts at the Salem Nuclear Generating Station with an alert or warning telephone call to the hospital with information that there has been a radiation accident, and one or more injured and contami-nated persons may require treatment. On receipt of such a call, the staff will' prepare to admit the patient (s) through the Radiation Emer-gency Area (REA). The REA will be set up in accordance with the directions i

given in Section E, " Procedure",

! 4. Hospital personnel will utilize protective clothing and personnel radiation l

dosimeters in accordance with directions contained in Attachment D. " Pro-cedure for the Use of Protective Clothing and Dosimeters". Decontamina-tion of the patient (s) as may be required, and the collection of contami-nation samples will follow the directions given in Attachment E.

8 .- PRECAUTIONS *

• There are 'three major types of radiation exposure which may cause injury:

l 1) penetrating radiation exposure from a source external to the body (gama rays, neutrons): .

_n

, Revision: 3

. June. 1984

^r3 Q 8. PRECAUTIONS (Continued)

2) internal exposure to radionuclides by ingestion, inhalation, absorption, or through a skin break; ,

3) skin and superficial tissue exposure by ' contamination of'the surface of

. the body with radioactive materials, including subcutaneous radioictive

'. foreign objects. '

A patient who has been excessively exposed to external radiation will not present a hazard to attending personnel. Radiation that has injured a patient will no more harra the attendant than heat that has injured a burn patient will harm the attendant. ,,

A patient who has received an overdose of radionuclides *by ingestion or inhala-tion is no more of a hazard than the patient who has been given diagnostic radioisotopes in a hospital nuclear medicine department.

An individual whose clothing, skin and/or wounds are contaminated with radio-

active material may present a radiation hazard to attending personnel in the absence of adequate procedures to prevent the spread of the contaminant or control of the fidiation exposure from the contamination. -

Since radiation injuries are not imediately If fe-threatening, primary atten-tion should always be directed to traumatic life-threatening injuries, e.g.,

severe bleeding, airway obstruction, shock. Concomitantly, or as soon as possible, the patient should be decontaminated.

C. PREREQUISITES

1. Alert / Notification As soon as it has been established by the Salem Nuclear Generating Station personnel that a patient will be transported to the hospital for treatment, an alert call to this effect will be given. As soon as this has been estab-lished, Salem Station personnel will notify the hospital, The alert and notification calls will be directed to the Hospital Switchboard Operator, (609)935-2000, who, in turn, will notify the Nursing Supervisor.

2

Revision- 3 June, 1984 C. PREREQUISITES (Continued) n

2. Prior Action at the Salem haclear Generating Station Before sending the patient (s) to the hospital, the Salem Station personnel will accomplish the following procedures: .

a. Administer first aid.

b. Notifyambulabce.

I

c. Call the hospital and inform them of expected arrival time, description '

of apparent iniuries and number of patients,

d. Decontaminate the patient (s) to an extent compatible with in. juries.

e. Assign station personnel qualified in radiation protectiod procedures to accompany the patient (s).

D. LIMITATIONS AND ACTIONS

1. Salem County Memorial Hospital is the only treatment facility where radio-actively contaminated accident casualties from the Salem Nuclear Generating Station may be treated without explicit approval of the Medica 1' Director of p Public Service Electric & Gas Company, b 2. All deconta,mination of hospital personnel, equipment, and facilities shall be supervised by Salem Nuclear C,enerating Station personnel.

E. PROCEDURE

1. Notification In accordance with C,1, Salem Nuclear Generating Station personnel will alert the hospital by calling the switchboard operator, who in turn calls one of the following persons in the order listed, during normal hospital hours.

a. Nursing Supervisor,

b. President.

c. Senior Vice President.

d. Vice President - Nursing.

The initial notification call will be directed to the Nursing Supervisor on duty who will obtain the following information:

'M a. Date and time of call.

b. Person calling:

i

' (1) Name ,

(2) Address '

(3) Telephone Number

_ __ _ e .

- q

' l Revision: 3 E. PROCEDURE (Continued)

The call will then be transferred to E.R. personnel for the following i infomation:

• l (1) Location. -

(2) Date and time..

(3) Number of patients.

(4) Extent of injuries.  !

(5) Contamination status, s (6) Expected time of arrival. .

l i.

The hospital President will contact and instruct: I

a. Switchboard Operator to declare Code Magenta * ('d' u ring normal hours).  !

b. Nursing Supervisor (durinn off hours). ' * '

c. Radiation Hanagement Corporation. (215) 243-2990 - 24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> emer9ency '

phone number r

2. Nursing Supervisor's Outies+

• Prior to Patient Arrival A. Complete the top of the form seen under Attachment 8 (page 8'-1) of this menval.

R. Notify Emergency Room physician and nurses. '

C. Report to Radiation Emergency Area and supervi'se preparation.

D. Assign nursing personnel to assist physician in treatment room.  !

E. Assign Control Point Attendant.

F. Assign Buffer Zone nurse, i

Patient Arrival Supervise all activities in treatment room and buffer zone, i

Upon declaration of Code Magenta, personnel associated with radiation medical l p*

( emergencies will report to the RCA and perfom their respective duties a; s

o NOTE: Should Nursing Supervisor be involved in a code, Emergency Room personnel will perform these duties, I l l

! L

2 Revision: 3 June, 1984 m E. PROCEDURE (Continued)

)

(

'v 3. Maintenance / Housekeeping Personnel's Duties Upon notification of Code Magenta, open and prepare Radiation Emergency Area as follows: , ,

Prior to Patient Arrival

'. Step 1 -

Clear treatment room of non-stationary supplies and equipment.

Step 2 -

Obtain radiation emergency supplies from storage closet.

Step 3 -

Lay floor covering (Herculite) throughout the REA. The pre-cut colored pieces are marked as to proper location.

a. Yellow Herculite, to be placed as follows: '

(1) Ambulance Entrance (outside door and anteroom -- weibht this p section).

U (2) Treatment Room. ,

(3); Ant,ercom. -

b. Green Wrculite -- Buffer Zone. .

c. White Herculite -- use for patient exit only.

Step 4 Attach decontamination table top to gurney and place 15 ga11on water receptacle under drain.

Place 32-gallon lined waste receptacles in treatent room and buffer zone.

Step 5 crect warning rope and signs across hallway and buffer zone.

_ Step 6 Attach hose with showerhead to faucet and adjust water tagerature to luke warm.

Step 7 O

LJ Open Decontamination and Sample Taking Kits on table in treatment room.

Step 8 If the possibility of two patien$s exists, move a second gurney to the area outside the REA unti1 needed. .

.e -

., Revision: 3

. June, 1984

y. -

E. . PROCEDURE (Continued)

4. Emergency Room Nursing Personnel's Duties *

• In absence of Nursing Supervisor, perform duties listed under E.2.

i

+ -

Prior to Patient Arrival A. Don protective clothing and dosimeters in accordance with directions contained in Attachment D of this manual. '.

B. Complete bottom section of form seen under Attachment B (page B-1) of this manual. -

Patient Arrival A. Assist attending physician in patient stabilization.

B. Collect bioassay samples in accordance with directions contained in Attachment E of this manual.

~ -

C. Assist in patient decontamination in accordance with directions

~

, contajried in Attachmdnt E of this manual.

D. Assist in patient transfer and exit procedures.

t E. Remove protective clothing and dosimeters in accordance with directions contained in Attachment D of this manual.

F. Insure the ambulance remains in innediate area until released by Salem Station radiation protection personnel.

~

f s.

I'.

.' . - . - . . . . -.. _... _-..._ _ _.. _ ___._ _ ..._-...-_ _ .... _ _ _. _ ._~.__. _ .._ _.__ _ ._ -.

Revision: 3 l l June, 1984 '

,g E. PROCEDURE (Continued)

5. Attending Physician's Duties Prior to Patient Arrival ,'

A. Assure that the Radiation Emergency Area is set up for admission of

', a radioactively contaminated patient.

. B. Assure that necessary medical supplies and equipment are brought to the REA. -

- C. Don protective clothing and dosimeters in accordance with directions contained in Attachment D and Diagram III of th,is manual.

Patient Arrival A. In the event of multiple patients, assure that appropriate treatment priority is assigned. Ifthepatientisnotcriticallyin[iured,he should remain in the ambulance and be admitted according to triage method.

B. Question the accompanying Salem Nuclear Generating Station,' personnel concehE55gthepatient'scontaminationstatusandprecautionsthat should be taken by the hospital staff.

C. Administer emergency treatment D. Insure that requested medical supplies are passed into decontamination /

, treatment room.

E. Decontaminate the patient and collect samples of the contaminant in accordance with Attachment E of this procedure.

F. Following decontamination and emergency treatment, direct the transfer of the patient from the REA to the appropriate section of the hospital for care or further treatment.

G. Remove protective clothing and dosimeters in accordance with directions contained in Attachment D of this manual.

LJ '

-7.1

. Revision: 3 June, 1984

[m)  :

.' v' E. PROCEDURE (Continued)  !

6. Control Point Attendant's Duties Prior to Patient Arrival -

A. Assure that the personnel entering the REA are wearing protective clothing, self-reading pocket dosimeters, film badges and ring TLDs.

B. Don protective clothing and dosimeters in accordance with directions contained in Attachment D and Diagram III of this manual.

C. Restrict access to only those personnel authorized entry .by the attending physician or Nursing Supervisor.

D. Maintain a record showing name, time and inittal dosimeter reading of each person entering or exiting REA. (Refer to Attachment J).

E. Record serial numbers of dosimeters, film badges and TLDs, as well as person's name (see Attachment J Personnel Dosimetry L69 ).

t Patient Arrival A. Assur,e, that no person or article is allowed to leave the REA (after theradjoactivelycontaminatedpatientisadmitted)untilithas been monitored by Salem Nuclear Generating Station personnel and found to be " clean", i.e. , free of detectable radioactive contami-nation.

B. P.ecord results of radiation surveys performed by plant radiation protection personnel on anatomical diagrams provided ir. the decon-tamination kits and Section J of this manual using a separate diagram l for each survey for each patient.

C. Record dosimeter readings and collect dosimetry from all individuals exiting the REA.

! -S-

Revision: 3 June, 1984

,\ E. PROCEDURE'(Continued)

7. Buffer Zone Attendant's Duties .

Prior to Patient Arrival }

A. Obtain medical supplies as requested by attending physician.

B. Don protective clothing and dosimeters in accordance with directions contained in Attachment D and Diagram III of this manual.

Patient Arrival '.

A. Pass medical supplies into treatment room as requested by attending physician. DO NOT ENTER TREATHENT ROOM UNLESS SPECIFICALLY REQUESTED TO DO SO BY ATTENDING PHYSICIAN.

B. Following emergency treatment and decontamination, prepare for removal of the patient from the REA. '

O (1) Roll white Herculite from hallway (Clean Area, Diagr&m II) into 1] Treatment Room.

~

(2) . Wheel in a " clean" stretcher across the white pathway.to the "J45ttion inanediately adjacent to the patient.

NOTE: It is important to remain on white Herculite while in REA to prevent cross-contamination.

(3) Assist in the transfer of the patient from the decontamination table top to the clean stretcher.

l l

i r

l l .

l J

\

l

?-

i

.g.-

')' ,

Revision: 2 March, 1984 E. .P_ROCEDURE (Continued)

8. President's Duties A. Upon notification from switchboard operator of impending oatient arrival from Salem Nuclear Generating Station, reqLesi that Code Magen'ta be declared.

g B. Assure that' a responsible hospital representative is available to address any media concerns.

~C. AssurethatarepresentativefromPublicServiceElectf,ic& Gas Company is available to address any media concerns. -

D. Provide additional support as required. - -

9 9

O ~

O OOO M S pe e

1 l .-

4 110-

3 Revision: 3 June. 1984 E. P_ROCEDURE (Continued)

9. Plant Radiation Protection Technician's (RPT) Duties Prior to Patient Arrival ."

A radiation protection technician (RPf #1) from the Salem Nuclear

, Generating Station will accompany the patient (s) in the ambulance and bring appropriate instrumer.tation. If staffing permits, a second radiation protection technician (RPT #2) will arrive at the hospital in a separate vehicle and assist in the duties outlined below. ,

~

Patient Arrival .[

~

RPT #1 A. Provide advice and guidance to attending staff regarding radiation exposure and protective actions. ,

8. Don protective clothing and dosimeters as provided by hospital staff.

C. Perform frequent radiation surveys of patient and attendants.

D. Maintain contamination control to treatment area.

~

E. Proyfde advice and guidance to hospital staff regarding collection

. of fanfples and decontamination procedures in a~ccordance with directions contained in Attachment E of this manual.

F. Decontaminate REA and equipment following patient and attendan' exit.

i RPT #2

A. Survey ambulance and attendants prior to departure. If contamination l

is found, ambulance should be returned to Salem Nuclear Generating Station for decontamination.

B. Control patient and attendant exit procedures.

C. Perfonn radiation surveys of patient and attendants upon exit from the REA.

D. Collect dosimetry from personnel exiting the REA at tennination of emergency and return to Salem Nuclear Generating Station for processing.

E. Decontaminate REA and equipment following patient and attendant exit.

O ,

h F. Maintain contamination control outside of treatment area.

- 1.1 -

i Revision: 2 March, 1984 F. l RETUR_NOFREATONORMALIUSE Once the patient has been decontaminated, the REA and all equipment will be surveyed, decontaminated as required and released as soon as possible by ~

I Salem Nuclear Generating Station radiation. protection persopnel.

G. PATIENT TRANSFER TO DEFINITIVE CARE CENTER

1. If it is determined by the attending physician, the Medical Director, Public Service Electric & Gas Company and Radiation Management Corpora-tion that the patient should be transferred to a definitive.' care center for the evaluation, diagnosis and long-term care of the radiation injury,

> this- patient can be transferred to RMC's definitiv.e care center located

, at the Hospital of the University of Pennsylvani~a'in Philadelphia.

2. Arrangements for transportation of the patient will be coordinated through Radiation Management Corporation (215) 243-2990 -- 24-hour emergency phone number. ,'

O H. PROCEDURE FOR HANDLING MULTIPLE VICTIMS

1. Multiple injuries occurring at Salem Nuclear Generating Statfon would b~

- ~

managed by utilizing the principles of disaster planning. These include triage at all levels of care and primary attention to life-threatening injuries. Radiation exposure and contamination should receive secondary consideration. Upbn notification from Salem Nuclear Generating Station that there has been an accident involving more than one patient, complete the fonn seen under Attachment B, Data Infomation Sheet. In addition, f

(- inquire as to the extent of medical assistance available bn-site. The Data Information Sheet should be given to the Emergency Room physician.

2. On-site medical personnel with the assistance of ambulance attendants should institute triage principles with primary attention to life-threatening injuries. The most seriously injured should receive priority evacuation.

-Minimum decontamination should include the removal of contaminated clothing.

If time, availability o,f. transportation and patients' medical condition warrant, further decontamination (e.g., bathing with soap and water) can be accomplished. Each contaminated patient sent to the hospital should be 12

.' Revision: 3

. June, 1984

' 1 i H. PROCEDURE FOR HANDLING MULTIPLE VICTINS (Continued) )

I accompanied by a trained radiation technician. Less serigusly injured l

victims should be completely decontaminated at the plant and be trans-ported to the hospital in a " clean" ambulance to the normil emergency l

. room entrance.

3. Prior to patient (s) arrival, Salem County Memorial Hospital should initiate its Disaster Plan for handling multiple casualties, as,well as its procedure for handling contaminated and injured patients. The medical triage team should dress in protective clothing (see A't'tachment 0). The present REA and/or Emergency Room area should be set up and ready to receive multiple contamination and injured 7atients.

4. Upon arrival of the ambulance the triage team should have the most seri-ously injured and contaminated brought into the decontamination / treatment i room. The less seriously injured should remain in the ambulance. A decontamination team should be assigned to beg'in decontamination in the

[VD ambulance. Contaminated clothing can be removed and collected an.d decontamina,telareascanb'e wiped with a damp cloth. If decontamination cannot be compieted, the areas should be covered with, plastic or cloth.

5. After the patients have been treated and decontaminated, the REA should be closed off; Salem Nuclear Generating Station personnel should survey and decontaminate ho:rital supplies, equipment, ambulances and the area prior to releasing it for routine usage.

l l

l

., AVdiU!ANCE ACCESS R0tfrd Revision: 1 June, 1934 STAFF BATHROOM

.O .,

c 7 SHOWE -

. AREA BUFFEil L ZONE 0---A

="iToaino (courao') eo MONITORING

' F STATION ---- ---

[ , , , ,

n MONITOR!? G (CONTROL) h POINT g RADIATION EtERGENCY v

AREA'

.. > s

_3

.< '1 I CONT #ilNATED AREA MONITORING (CONTROL POINT __

] -

i ll i - STORAGE AREA

~

SUPPLY > )

l 3 T/

NSIX.ANCE PERSOPNEL HOLDING AREA i

- 'i _

Vf Radiation Emergency Room l

Emergency Entrance Area Entrance i

% Contaminated Medical Personnel Flow p Clean Medical Personnel Flow DIAGRAM *@

Patient Flow

~

i l

)

l J~ '

Revision: 2 )

March, 1984 '

m S

i .

O e

g et e, e

, *O 9 ATTACHMENT A QUICK SORT PROCEDURE FOR HANDLING ANY RADIATION ACCIDENT VICTIM ,

• e e m Wge e m $m l

l l

l I

l l

i l r -

(

l.

l

Revision: 3

', June. 1984 ATTACHMENT A Procedure for Handling Any Radiation Accident Victim at

'the Emergency Room ~

(

i

1. Ascertain whether the patient is CONTAMINATED (Use Geiger !!ueller Tube)  !

'. A.- If so ... Admit 'the patient to ?EA Ambulance Entrance when set up as Radiation Emergency Area (REA) )

B. If not ... Admit to nomal Emergency Room C. If in doubt ... Admit patient to REA .'.

'2. Treat traumatic injury. ..

3. If contaminated, decontaminate in REA

4. Call for assistance .

- Attending Staff, Emergency Room ,'

p)

(

.- Radiation Management Corporation (RMC):

Philadelphia (215) 243-2990 / (215) 841-5141 Chicago.. (312) 291-1030 .

PROCEDURE FOR ADMISSION OF UNANNOUNCED ACCIDENT VICTIM (S)

BY EMERGENCY ROOM PERSONNEL Admission Guidance is provided for the unannounced arrival of accident patients under two circumstances: (1) Emergency Room personnel become aware of the patient's status as a " radiation accident patient" before the patient has been removed from the ambulance; and (2) the patient has been brought into the Emergency Room before his status as a " radiation accident patient" has been detemined.

Patient Stili in Ambulance If general medical condition warrants, sustain patient in ambulance, instruct driver, attendants, and Emergency Room personnel who have been in contact with the patient to stay in the vicinity of the ambulance (but not inside the ambulance).

Q v

AI

' Revision: 2 March, 1984

{-

V .--ATTACHMENT _A_(Continued)

_P_atient Still in Ambulance (Continued)

Clean an area of about 8 feet around ambulance and keep unnecessary personnel and vehicles away. Attend to patient's medical condition as required. Use surgi-cal gloves and mask. If innediate life-saving mdasures are not necessary, observe

. pa.'tient from a distance. All equipment and supplies used to attend to oatient MUST stay in vicinity of the ambulance. D_0_ NOT carry anything back to the Emergency Room.

Immediately request assistance from Salem Nuclear Generating Sta ion and Radiation Management Corporation. Then: '

- Request of Emergency Room staff that the Ambulance Eh~ trance at the REA be set up as a Radiation Emergency Area; . . .

- Clear every person out of REA before bringing patient in;

- Instruct driver to stay with ambulance until a radiation survey has been made;

- Bring necessary equipment and supplies to treat patient from Emergency Room to REA. All equipment, supplies and personnel entering REA' MUST

/m\ stay there until arrival of radiation monitoring personnel. EstaE1Tsh a guard at the door. Pass Emergency Room supolies and equioment into

'REA; but D0,NOT allow personnel and equipment to come out; and

- Personnel attending patient in REA should stand next to patient only as long as fifcissary to perform life-saving measures. At all other times, stand about five to eight feet back and observs oatient;

- Only persons attending the patient should be in the room.

_ Radiation Status Discovered After Admission to Emergency Room

- Innediately secure the entire area through which the patient has passed or is located. Keep all personnel and equipment in the area. D0_ NOT allow anyone or anything to leave;

- Establish a control point through which necessary personnel and equipment pass into restricted area;

- Make arrangements to admit other patients to uninvolved area of Emergency Room through the outpatient entrance.

- Attend to patient's emergency medical condition as required. Use surgical gloves, mask and gown when treating patient. If immediate life-saving measures are not necessary, observe the patient from a distance (five to eight feet). Innediately request assistance from Radiation Management g Corporation or Salem Nuclear Generating Station (see Telephone Directory, Attachment !). '

A-2

- __ __ . __. __ _ _.._.~ -_ _- _ _. _ _. __ . . _ . ... . . ___ _ _ - . _ _ _ _ . _ _ . _ . _ _ _ . _ _ _ _ _ _ _

. . Revision: 3 f.'- . June, 1984 l

L l

l -

I

'i . I I-i '

i ATTACHNENT B  !

1 I'

TELEPHONE PROCEDURE FOR NURSING SUPERVISO.R. - (

l~ AND EMERGENCY ROOM NURSE o

I 6

n L i 4 f.

3

l e . .

m e $6 I

i o <

r es- rv < r e ww e e -m,r e- r..-v-- =- -=v w we.-eee-,,w- a-am---.,vmo esm mem _.-me<_-

+.

' Revision: 3 ATTACHt4ENT B DATA INFORf1ATION SHEET

The Nursing Supervisor should obtain the following information fr6m the caller:

Date-and Time of Call:.'

3- .

. Person Calling: ,

- Name

.

Address: . .

Telephone Number:

The Emergency Room Nurse will obtain the following:

i

. Accident:

Location: -

.Dateandfjme:

Number of Patients:

i-

, Extent of Injuries:

1 Contamination Status:

1

! ~ Expected Time of Arrival:

i '

O l 8-R

Revision: 2 March, 1984 l

e 6

6 t

4 i

e*

• e 4 ATTACHMEllT C .. .

EMERGENCY TREATMENT OF RADIATION ACCIDENTS 9

4

+

0 e e e e #9 e e se e .

e f

9

. .- ... . . . . _, . . . , -..-- - - . - , , . , - , . , . . .e_-.ce, , , . , , . . , , . ,,,en,cn,,,, ,,--,.n e _ , e m ,,w,- ww - -, ,m w , ,,n,--+,,--cn

. Revision: 3

. June, 1984 ATTACHMENT C

. EMERGENCY TREATHENT OF RADIATION ACCIDENTS

~

GENERAL -

Emergency treatment of. radiation accidents may have to be given before contact with or arr,'ival of specialists hading expertise in evaluation and management of these accide'nts. in this case the' management of the patient should take place in the following order:

A. Resuscitation and Stabilization. l B. Initial Decontamination. "

C. Evaluation of Radiation Status. ..

D. Initial Treatment of Radiation Injury. ,] '

A. RESUSCITATION AND STABILIZATION Since radiation injury is not feinediately life-threatening, primary attention should always be directed to traumatic life-threatening injuries -- maintenance

' of airway, arrest of bleeding, treatment of shock and control of pain.

B. INITIAL DECONTANINATION -

~'

Concomitantly w4th-t'he procedure above, or as soon as possible, the patient should be decontaminated. In the initial decontamination . . . . .

Remove all clothing; Obtain samples of contamination (. skin smears, tissue, fluids, etc.);

Survey with a Geiger Mueller monitor and note levels of contamination on Patient Radiation and Medical Status Record Sheet (see Attachment J);

Remove obvious dirt and debris; bathe, if necessary while protecting

, wounds; Repeat surveys and sampling as necessary; l

Flush wounds with copious amounts of sterile water and/or saline; Flush orifices with water or saline. Do not allow patient to swallow; ,;

Stop with initial decontamination when activity levels are measured in the few thousand counts / minute; See Attachment E for details on decontamination and sample taking.

'~ '

O,

~

I l '

C-1  !

2' Revision: 3

. June, 1984 b) 6 ATTACHMENT C (Continued)

C. EVALUATION OF RADIATION EXPOSURE STATUS History:

}

When did the accid,ent occur?

'. Source of accident'?

, Type of radioisotopes involved?

How long was patient in accident environment? Where was he in relation to radiation source? Was there airborne contamination? Was th'e patient wearing breathing apparatus? Was there surface contamination?" Any skin broken? Was source in contact with body? Was the patient wearing dosi-meters?

• Dose Evaluation:

This will require the assistance of persons knowledgeable in radiation.

This assistance can be by someone on location or by telephone. ,'In any case, gather as much of the following infonnation as possible: .

(Aj -- Dose rate (gamma, x-ray, neutrons, etc.) as measured by instruments in accident environment;

- RadiaNon exposure reading on patients' and others' dosimeters (TLD ' film badge, pencil dosimeter);-

- Level of residual contamination (beta, ganms) on patient using survey meter (mark areas on Patient Data Sheet --

see Attachment J);

- Neutron exposure? Collect metal objects, hair or nafis; and 1

- Calculation of dose to the patient and to attendants. -

t l

D C-2 I J

Revision: 3 June, 1984 A ATTACHMENT C (Continued)

U Clinical Picture: A good estimation of the severity of the patient's external, total body exposure can be obtained by observing the following clinical symptoms .

and signs:

• - Nausea and vomiting ... S 100R*

Beginning within 2 hours2.314815e-5 days <br />5.555556e-4 hours <br />3.306878e-6 weeks <br />7.61e-7 months <br /> >400R Beginning after 4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br /> <200R None within 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> < 75R

- Erythema ... >300R (total body); >600R (surface contact)

- Diarrhea ... >400R

- CNS' symptoms ... >2000R to the head

- Serial lymphocyte count within 48 hours5.555556e-4 days <br />0.0133 hours <br />7.936508e-5 weeks <br />1.8264e-5 months <br /> ...

i.

. 1200/m good prognosis ,

300-1200/m 3 9"" *

• 300/m poor prognosis

• Rems, air exposure.

D. INITIAL ~TREATHENT OF RADIATION INJURY Detailed Decontamination: It is particularly important at this stage to remove high level contamination caused by penetrating missiles or splinters in wounds.

Overexposure: Since overexposure to radiation results in a slowly unfolding i

course over a long period of time, there is little in the way of specific treat-ment in the initial stage of the disease. Treatment is symptomatic and consists of making the patient comfortable and allaying his fears. He may require anti-metics, fluids, sedatives and analgesics.

Order CBC with differential stat, at 4, 8 and 12 hours1.388889e-4 days <br />0.00333 hours <br />1.984127e-5 weeks <br />4.566e-6 months <br />.. Obtain blood sample (10 cc sterile heparinized blood) for chromosome analysis. Keep sample chilled in ice water.

Internal Contamination: Except in a few instances, there is also little to offer 8 in the way of specific treatment in the initial stages.

C-3

etev i s ion : c

. March, 1984 ATTACHMENT C (Continued)

.m

'. Internal Contamination (Continued)

Generally, specific treatment to eliminate any absorbed radioactivity requires rather detailed and complex analyses, including bioassay of excreta and blood, and whole body counting. Begin 24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> urine collections and 72 hour8.333333e-4 days <br />0.02 hours <br />1.190476e-4 weeks <br />2.7396e-5 months <br /> continuous fecal; collections. Arrange ~for whole body count as soon as patient's condition warrants. Arrange for thyroid uptake study for I-131.

If it has been determined that an appreciable amount of radioactivity hds been ingested (which is seldom the case), a stomach lavage, emetics (ZnSO 4

) or cathar-tics (10% MgSO ) may be indicated. ..

4 If it has been detemined that the patient absorbed considerable amounts of...... ,

Tritium (3 )H . . . . . . . . force fluids Radioiodine. .. .... ..give Lugol's solution or other thyroid-blocking agent inrnediately (reduces thyroid uptake of I-131 by 50% if given within 4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br /> post-exposure; pro-bably not effective after 12 hours1.388889e-4 days <br />0.00333 hours <br />1.984127e-5 weeks <br />4.566e-6 months <br />)

~

.PRINCIPLESOfkADIATIONPROTECTION

'~~

Certain precautions to minimize exposure to attendants are necessary when dealing with a patient who has external contamination, specifically:

- Always wear surgical scrub suits, masks, caps and gloves;

- As few attendants as necessary should be in the same room with patient;

- Only in the performance of emergency treatment and initial decon-tamination should attendants be next to patients. At all other times, e.g., while evaluating the patient, attendants should stand at least five to eight feet from the patient and observe him from a distance if radiation levels are excessively high;

- Rope off and control the area in which the patient is being treated.

'ALL persons, equipment and supplies that enter this area MUST stay

! YEre until Radiation Emergency Teams arrive to assist in the moni-toring and decontamination of people and equipment;

' Suggested pemissible levels of attendant exposure in the course of treating a patient are: -

TOTAL to SR .......... routine treatment and decontamination B0DY to 25R .. . . . . .. . . emergency treatment and decontamination EXPO- to 100R . . . . . . .. . 11fesaving treatment and decontamination SURE C-4

i i-Revision: 3 ATTACHMENT C (Continued),

Principles of Radiation Protection (Continued) '

~

To estimate beta exposure use disc shaped monitor handle covered with plastic glove and pass over body approximately 1 inch from surface. If the reading is SR/ hour, an estimate of attendant exposure would be SR; treatment should take one hour.

-Experience shows that it is e'xtremely unlikely that an accident would be so severe i

that an attendant would receive an exposure of even SR. In high radiation fields personnel may be rotated in order to minimize the exposure to any single ~ individual.

It is also suggested that anticipated' exposures over SR should be on a vol,'untary basis.

INITIAL BI0 ASSAY SAMPLES .

Each of the following bioassay samples should be obtained as s30n as possible and labeled with name, date, time and type of specimen. Avoid cross-contamination of samples from external sources of contamination or from other samples.

-Blood: .' -

1) 10 cc for radiobioassay;

2) 5 cc (sterile heparinize.d) for chromosomes; keep samples chilled,in a glass ofl ice;

3) 10 cc oxpted for hemogram and differential *

4) 10 cc for:

a) chemistries; b) electrolytes -

. Hair, nails, metals from neutron-exposed patient; Urine:

1) first urine;

2) 24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> urine for several succeeding days

Feces, total sample for several succeeding days;

} Sputum; Vomitus; Tissue and tissue exudates (note' location);

! Irrigation fluids (note location); and l

Filter paper or cotton smears of orifices, wounds, skin areas (note locations).

O*

t differential - repeat t.i.d. for 3 days or more frequently if clinical solu warrants.

l. .-

i-I fR-@

. -, _ . ~ _ . . - .. _ . .. _ - - . . . . - . - . - - . . - . - - - - . . - - . . . . . - . - - - . . - . .

L L

e Revision: 0 l

December, 1980

+-

i l .

f- ,

} .

• i s ,

I .

i i

I i

i 1 ATTACHMENT D .. ,

( . . .  !

PROCEDURE FOR THE 'f '

4

. USE OF PROTECTIVE CLOTHING AND DOSIMETERS i i

.. j l~ l t * .

t r i s I

h l

L I

l. b l

i i ..  ;

l= r F

r o

E f

l

'_ J

(

l.

L (3 l

(

[

i 4

i, i

Revision: 1

. June, 1984 ATTACHt1ENT D i

PROCEDURE FOR THE USE OF PROTECTIVE CLOTHING AND DOSIMETERS A11' work past the Monitoring (Control) Point requires protective cl{ thing, independent of the degree of contamination present on the patient or his clothing. Each person (ntering REA should don two surgical gowns, two set's of surgical gloves, and two vinyl aprons, A mask, cap and' shoe covers, as well as dosimetry. (See Diagram III for donning

'pmtective clothing and proper placement of attendant dosimetry). After gross decon-tamir.ation is completed, the outer surgical gown, gloves and apron are removed. Wound care and decontamination will then be attended to. ,'

4 Removal of Contaminated Protective Clothing ,,

Upon completion of their activities in the Radiation Emergency.'}ntatment Room personnel will pmceed to the Monitoring (Control) Point between the Treatment Room and the Buffer Zone (Diagram III). They will remove their protective clothing and personnel dosimeter in the following order: -

(1) self-reading dosimeters (read and' recorded by Control Point Atte'ndant);

(2) headwear and mask; (3) apron and gown (turning them inside-out);.

(4) footwear an_d, gloves (remov'ed at Step-Off Pad).

~ '

Clearance Procedures After having removed protective apparel, each person who occupied the Treatment Area will be monitored prior to leaving the Buffer Zone. If no contamination is found,

~

personnel may proceed to the change area and put on their normal clothing.*

• If contamination is found, personnel will remain in the Buffer Zone, away from the normal exit. Salem Nuclear Generating Station personnel will direct them through

a decontamination process utilizing the water supply, soap and water collection system available in the treatment room. A final survey will be performed at the control' point prior to entering the clean part of the hospital.

Use of Dosimeters Dosimeters will La supplied by the Monitoring (Control) Point Attendant to all per-

, p sonnel entering the Radiation Emergency Area. .

A 0-1 '

. .-- . . - . . - - . - . _ - . . - . . . . - . . - - - _ ~ - . - - . - . . . - - . - . -

Revision: 0 December, 1980 ATTACHMENT D (Continued)

/_T C / Use of Dosimeters (Continued) t Dosimeters are of three types:

1. Direct reading dosimeters (" pen dosimeters") to monitor exposed dose on a continuing basis. These must' be recharged to read "zero" before

~

. they are distributed to each attendee.

i

2. Badge dosimeters - to form a permanent record of exposure.

3. Ring dosimeters - to form a pennanent record of finger exposure.

. Dosimeters are to be worn in the followinq manner:

1. At the neck line, clipped under the protective clothing;

2. On the ring fingers of hands, under the gloves, with detecting element at palm surface.

Upon leaving the Radiation Emergency Area the wearer shall surrender his dosimeter to the Control Point Attendant, who will record the reading and number of the pen

. ,e dosimeter and retain the badge and ring dosimeters for later process'ing. The Control Point Attendant must assure that the records clearly show the serial number ,

of each dosimeter and period of time worn by each individual who occupied the Radiation Emergency Area.

O, D-2,

.,_....._m.,_ . _ _ , - _ , . . . , _ _ , _ , . _ . ..__,_.w,,,_ . , . _ _ . , _ . . . ,

7-~g ~. -

\_j V

(_, .

/ y M' '

7

-naec p/ \ ,

4 Rad'alion Management Co'poration 3508 f.iarket Si b P.O. Box 7940 PENCIL i <c Philadelphia, Pennsylvania 19101 f' DOSIMETER -- ( l TLD B ADGE

/ j J

,J v(

C .

/

k / RING d l L / DOSIMETER

/

ATTENDANT GARB  !  ! ')

\ ll%' l A! SURG 1C:

DRESSING S E O'U E N C E ' INNER ,

/[f(jhljb G L O '.' t APRON

1. Scrub suit. OUTER , ,

2. Protective Shoe Covers. APRON INNER am

3. Rihg TLD (Record * ). OUTER . GOWN

4. Ctdge TLD (On Shirt Pocket - Record

• l' GOWN cg g.

5. lat Gown, p /- . v,

6. let Apron. . b- > .

i

, 7. 1st Pair Gloves (Over 1st Gown Cuff) .  !

% _. ~$3

.o l 8. 2nd Gown. . f l 9. 2nd Apron.

, 10. 2nd Pair Gloves (Over 2nd Gown Cuf f) . ) \

! 11. Cap and Mask. - '. !

12. Self Reading Dosimeter (On 2nd Gown -

A TAPE

\ /

Record *

• Zero). ,

v DIAGRAM Ill i

Revision: 2 March, 1.934 0 .

d k

ATTACHMENT E PROCEDURE FOR PATIENT DECONTAMINATION AND SAMPLE TAKING O

O .

O 8

- - ---n,--w-r ,m_, ,v-v---ew--a <-~w--~*--v -,,swo- ,- r~,~,w,w<-,-ww-mwww-~w-www- ~~~-owe m v wv s v w o-~-m

Revision: 3 June, 1984 ATTACHitENT E U General

,.I These procedures cover the use of the Decontamination and Sample Taking Kits.

The kits provide all the necessary items for the decontamination of a radioactively contaminated patient and the collection of specimen's of this contamination.

The collection of specimens is a prerequisite for a thorough evaluation of the medical and radiation status of the patient. It should be performed in con-junction with patient decontamination.

Attachment F provides a parts list for each of the two kits. There is also a parts list in each kit. Following use, the lists should be consulted for replen-ishment. The intended use of several of the items is indicated on the parts list.

Patient Decontamination Procedures Principles The objectives of decontamination are:

1. to prevent injury caused by the presence of radioactive substances on the body; p

'd 2. to prevent the spread of contamination over and into the patient: and

3. to prevent attending or (in extreme cases) from personnel from being exposed to abecoming contaminated source of radiation. the Although decontamination should be started as soon as possible, primary attention should be given to the alleviation of life-threatening conditions created by traumatic injury.

Decontamination is essentially the physical removal of radioactive material from the skin, wounds, or body orifices. Most decontaminants contain detergents or other chemical agents to facilitate this removal. Therefore, most decontaminants are suitable for decontamination of the intact skin only, and are not appropriate for wound cleansing or irrigation of body orifices.

Decontamination is performed in the following manner:

1. from the highest level of contamination to the lowest;

2. starting with the simplest procedure (e.g., soap and water) to more A complicated procedures;

3. with due regard to contamination of wounds, body orifices, etc. (see

' below for specific guidelines).

E- l'

Revision: 3 June, 1984 ATTACHMENT E (Continued)

P - Patient Decontamination Procedures (Continued)

Usually, the effect of decontamination is greatest in the earliest stages, i.e., most of the radioactive material is removed during the first decontamination effort. Continued decontamination may show diminishing effectiveness. At some point a decision hat, to be made to either accept some residual contamination, or proceed with the use of more potent decontaminants (more specific guidelines are seen below).

Decontamination Procedures In some cases decontamination may have been started before the patient arrives at Salem County Memorial Hospital. The extent of decontamination will be dependent upon the injury or illness.

A. General Two general rules apply to the performance of decontamination:

C 1. Check the effectiveness of the technique applied by monitoring

( -

periodically; and

2. Avoid the spread of radioactive materials from the area being decontaminated to areas of lesser contamination by covering the adjacent area.

Decontamination sequence should proceed as follows:

1. Wounds and adjacent skin;

2. Body orifices and adjacent skin;

3. High level intact skin;

4. Low level skin areas.

(

B. Steps To Be Taken For Decontamination and Sample Taking j 1. Judge whether the patient's medical condition requires immediate intervention; stabilize wound, if necessary, and redress for later decontamination;

2. Obtain a briefing from Salem Nuclear Generating Station personnel as to the contamination status of the patient, the exposure of the patient, and as to the specific measures to be taken by attending personnel with regard to their protection; e

E-2 ,

k L

~-

3p ,

Revision: 3 June, 1984 ATTACHMENT E (Continued) i Decontamination Procedures (Continued)

B. . Steps To Be Taken For Decontamination and Sample Taking (Continued)

3. Remose all clothing and monitor the patient with the radiation survey instrument by scanning the entire body (holding the probe about 1/2 inch from the skin), and record the findings on the Patient Data Sheets;

4. Obtain patient samples in accordance with' Procedures for Sample Taking, which follow. COLLECTION OF SAMPLES SHOULD BE PERFORNED PRIOR TO DECONTAMINATIOH;

~5. Perform a gross decontamination (see Decontamination of Skin and Body Orifices which follow);

6. Clean up room and remove outer garments from attendants;

7. Proceed Decontaminationwithof Wounds wound; survey)and decontamination (see Proc

8. Complete detailed decontamination of patient;

9. Transfer patient to " clean" area of hospital (see Diagram IV).

Waste material will be appropriately collected and returned to Salem. Nuclear Ger.erating~ Station for disposal.

C. Decontarination of Skin

1. Take smear sample of area-(see " Sample Taking Techniques and Indications");

2. .

Protect adjacent area if indicated by covering with towels;

3. Cleanse skin area; wash thoroughly with Turco soap and tepid water, using either cotton balls, preop sponges or surgical brushes; cover area with a good lather; rinse off after two to three minutes with copious amounts of running water; monitor; record results;

4. If contamination persists, repeat step (3) once;

5. If contamination still persists, try gentle application of clorox or hydrogen peroxide. NOTE: Avoid any of these entering wound or body openings. Repeat a few times using new cotton balls; remove decon-taminants with water; monitor; record results;

6. After complete decontamination, dry skin and apply Nivea cream to abreded or injured areas;

7. If residual contamination is present, consult with radiation specialists to decide whether further efforts are indicated; if it is decided to accept residual contamination, dry skin and apply colloidin, mark the area involved and record;

8. Collect all materials used and place in separate labeled containers.

O NOTE:

In case of serious contamination around a wound, rapid removal of the bulk of radioactivity can be obtained by shaving. In case of

( serious contamination of hair or under nails, clip nails, remove hair and retain; scrub thoroughly and repeatedJy with intermittent surveying. * .

.n Revision: 2 March, 1934 ATTACHMENT E (Continued) p

)

6 Decontamination 'Procedurbs -(Continued)-

C. .'DecontIminationat Body Orifices 'l i

1. ~T de samples of' activity in nostrils, ear-canals, and other orifices ' ,

.(ahindicated (see ." Sample Taking Techniques and Indications");

.--2..: Decontaminate area ~ surrounding orifices;

.C 3.s Gently. clean orifices using wetted swabs; 4[Yfnoseswabindicatessignificantradioactivityinnasalcavity,use.

nasal blows and nasal irrigation;

5. Collect all materials used and label containers.

E. Decontamination of Wounds N 1.c Dse aperature' drape to isolate the contaminated wound; Survey and take samples of wound (see " Procedures for Sample Taking");

^{ '~

2g

3. Decontaminate skin adjacent to wound:

z yw 4. Depending on surface and depth of wound, irrigate wound with sterile saline, dab with gauze pads soaked in sterile saline to cleanse wound

l 'W t collect all materials used and place in separate labeled containers:

l y-(; 5. Remove obviously necrotic and devitalized tissue surgically; keep all tissue specimens removed:

y7 Repeatedly monitor wound; record results on patient record sheet; 5- :6.

'} 7. If contamination persists, consult with RMC to determine further course of action; y-

8. If wound is clean, treat wound as necessary.

2 Procedures forsSample TakIng

[b The objectives of collecting specimens from a radioactively contaminated patie Principles Ktt.C are-as.follows: $^

- ).

1. To evaluate the amount and composition of the radioactive contaminants on.and in the body;

2. To obtain data with-regard to the patient's exposure to external radiation; and \

3. To supply information on the biological injury inflicted by the

[

radiation.

llected routinely:

. To meet these objectives, the following types of specimens are co

n. Materials containing the external contaminant (swabs, smears, tissue

' 1.

b ;c ) j samples, contaminated cleansing fluids, etc.);

t 2.- Specimens containing internal contaminant (feces, urine, sputum, etc.):

i, \

% E-4 4

gl l N _ _ _ _ _. _ . . _ __ _,__

i 6.1

• q ~

I

= 0 O,

- , W -: I I

^

CLEAN FLOOR COVERING  ;

AS UTILIZED FOR PATIENT TRAN .

i i .

i Decontamination and Treatment Room l -

1. i.'.O.

i.3

.' nJ ',5~..

,e >

. ~ ., 9.?,F l

$w g$ '" ' ' /

i

. ~

s.s l-  ; -

l ~,\jn}f.}f, r: d '

i . ; .jf,', .

1 r >

l ,

CLEAN n 8

AREA

.}

38 2"

lv '

lf i

e t

l t

L _ _ _ _ _ _ _ _ - - _ . - - -

Revision: 3 June, 1984

-ATTACHMENT E'(Continued)

Procedure for Sample Taking (Continued) q 3.

-In case of neutron irradiation .:.. materials in which neutron inducedil clippings radioactivity may be present (gold rings, buttons, hair, ni

-4. hematological specimens (whole blood in heparinized, oxalated, and un-coated tubes; blood smears).

~

'As the analysis of radioactive samples with regard to their composition is only possible in samples with a relatively high radioactivity, care should be to collect and store these samples separately from the usually bulky samples rather low activity (such as cleansing fluids, drapes, towels, etc.).

k ) may A' sample which is-not identifiable as to its source (location, time ta en therefore, take care to properly collect, store, and be' practically worthless:

mark _ all samples.

Sample Taking Techniques and Indications

'Esternal Contamination: '

-Before decontamination, the following samples shall be obtained:

use Nucon smear pads, 2moisten with a few drops of water,

1. -Skin Smears: (4" X 4"), if possible, by

'and smear a skin area of about 100 cmallowing sticky side of place smear on record paper, smear pad over the surface to be sampled: 2 and record location and time and area smeared, if other than 1 place in envelope.

nants. for later examination. +

2. Take samples of nails, hair and collect metallic objects (rings, watches glasses, belt buckles, etc.).

Wound Samples: use either one of the following methods:

3.

- for large wounds with visible blood or wound fluid -- obtain a f few cc using an eye dropper or syringe; transfer to bottle and L

label;

- for superficial wounds -- rub gently with cotton swabs; return ,

to tube and label; g - for wounds with visible dirt or debris -- remove with cotton tip l

or use tweezers; transfer sample to small glass vial and label.

hternal Contariination:

l i

1. Body Orifices: wet 0-tip with a few drops of water; swab, and store l dp in waterproof envelope and label.

collect urine

2. In all cases where internal contamination is expected:

l

and feces in containers supplied, and record time of voiding.

1 .

L

_ , , _. _ _ _ _ _ _ __.. _ _. _ _-6_ . _ _ _ _ . _ _ _ _ . _ . _ _ . _

E

Revision: 2 March, 1984

/T ATTACHMENT E (Continued)

\~ /' Sample Taking Techniques and Indications (Continued) l External Exposure:

- In a11' cases where a total body exposure is expected-  !

F ' 1. Obtain 10 cc of oxalated b1 cod for complete blood count and differential;

.2. Obtain 10 cc of sterile heparinized blood for chromosome analysis;

3. Obtain 10 cc blood for electrolytes and chemistries.

Record time these samples ware taken.

NOTE: Return bioassay samples to kit.. With any specimens necessary to the energency medical treatment of the patient which are obtained

' prior to completion of decontamination and are to be processed in

-the hospital laboratory, be sure to clean the outside of the specimen container (test tuba, ett } and have it surveyed before handing it out to- the buffer zone attendant.

o O

4 i

i O I l

E-7 y ,,,-..,,,,--,r, -+,,-,-w . . - , ,---.-m ....-%--- - - - , , - - , . -,#. - - - . - . - .ce .,##,..w-c-#,,---.-, ,,,-v, , - - - - ---,+-..~-,# 1,w e,. .

Revision: 0 December, 1980 0

i 4

ATTACHMENT F PARTS LIST FOR DECONTAMINATION AND SAMPLE TAKING KITS O

l 1

I t

O l '

l f

Revision: 0 December, 1980 ATTACHMENT F.

. DECONTAMINATION KIT 0,uantity Skin ~ Decontamination Absorbent Balls,. extra large 1 box Sponge-holding ~ forceps

• 1 P1astic' Beaker, large - 2 Preop Sponges 6 Surgical Scrub brushes 10 Wash Bottle (for localized contamination) 1 4 Decontaminants (Skin Only)-

Turco decon soap, bottle (for first decon effort: '

I general)

. Clorox, bottle (for second decon effort) 1 Hydrogen Peroxide 22 (H 0 ), bottle * (for third decon 1 effort)

• shelf. life - three years Wound Cleansing Gauze pads, sterile 50 t

Sterile Surgical Gloves, assorted sizes 8 pair Solution bowl, plastic 1 Syringe, 50 cc 1 4

Cotton-tipped applicators 100 ,

Aperature Drape 1 Decontaminants(Wounds)

Saline Solution, normal *, sterile bottle 1 Betadine Surgical Scrub bottle 1 Treatment Agents Nivea cream, jar 1 4 Colloidin, bottle 1

• shelf life - two to three years O

F-1

Revision: 0 December, 1980 ATTACHMENT F (Continued)

DECONTAMINATION KITS (Continued)

]V' ~

Ouantity Miscellaneous Materials 1

Prep Kit .

Scissors, heavy duty 1 12 Patient Radiation and Medical Status Anatomical Diagram Plastic bags, as.corted sizes (to hold decon 8 materials after use) 1

. Tissue paper, box 1

Notebook 2

Pencils Finger-Nail Clippers 1 SAMPLE TAKING KIT ,

Sample Type Samplino Instrument Ouanti.ty

. Nasai swabs 4 swabs 4 Aural swabs 4 Oral swabs 4 Skin Folds Swipes swabs 4 Swipes Nucon Smear 25 slots small container 4 Hair Nails small container 4

- Metallic Objects medium container / 2 small plastic bags 2 large Blood 10 cc vacutainers 2 heparinized (green)

I oxalated (gray)

I sterile (red)

Urine (24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br />) 2000 cc plastic container 1 Feces fecal container 2 swabs 4 hVWound Exudate eyedropper & bottle 2 Tissue containers 2 small 2 medium Vomitus fecal contafner 2 Irrigation fluids 100 cc plastic bottle 2

- o,

Revision: 0 December, 1980 ATTACHMENT F (Continued) l- _.g.

SAMPLE TAKING KIT (Continued)

Quantity Miscellaneous Items Envelopes 10 Labels 50 Pens 1 grease l ': I writing i Scissors 1 Tweezers- 1 Clippers 1 t

1 I

i ,

)-

k 4

f k

l t

1 h

1 i

i -

F.3

-~.svvw,+ ~ -ww- w,w. me--e~e,- www- v r .. ,w.

Revision: 2 March, 1984 i

d O

b i

ATTACHMENT G REA STORED SUPPLIES & EQUIPNENT o

O f

a 1

i r

i O

9 4

v e r w w-v e ,- - - ~ - - - , ~ - , - -

Revision: 3 L- '])une,1984

(%)

INVENTORY OF THE RADIATION EMERCENCY MEDICAL SUPPLIES & EQUIPMENT Salem County Memorial Hospital February 8, 1984 ITEM OUANTITY Decontamination kit, complete w/ 1 instructions E-Z Prep Hydrogen Peroxide Sodium Chloride Solution ,

Betadine Sample Taking Kit, complete w/ 1 instructions Decontamination Table Top complete I w/aplash guards and stretcher insert .

Barrel, 20 gal., mobile, white plastic 1 N

Barrel, 32 gal., w/ mobile base 3 Herculite, white, green, yellow sufficient 1

Lead pig Poster, " Radiation Accident" 1 (1 framed) 1 Poster, CPR Paper, brown kraft, roll 1 Rope, yellow / magenta sufficient Shield, mobile, lead glass 1 1

Showerhead w/ hose Sign, radiation warning w/ inserts 9 Sign. " Caution Radiation Area", metal 1 a

?

Step-off pad f-

, D Tape, masking, 7" 7 t

e

-- , , - - - - - - - --._--a ,-w - ,

. y---,-- - --

---

,,-,,--,------.w.-- ,,--,--,nn-----m ---,e-- - --. - ~- - - - , , - - -

Revision: 3 h

7.une, 1984 l 2-ITEM OUANTITY INSTRUMENTS:

-Charger, dosimeter - Johnson 1

+ Model CAT 6 S/N 24 .

Dosimeter, SRD, 0-1 R 9  :

Celger Counter 1 Eberline Model E-520 S/N 3107 Count Rate Meter 2 each Eberline Model E-140N S/W 1090; S/N 1086 ,

Constant Flow Air Sampler 1 RADECO Model HD 29A ,

- S/N 0582 .

(m) Class Filter 47 mm sufficient Radiation Monitor with HP210 Probe 1 RMC Type Eberline Model RM-14, S/N 3999  ?

TLD, control 1 TLD, badge 10 TLD, ring 10 NOTE: Instruments maintained and calibrated by plant EOUIPMENT:

! Air vent plugs 5 Ambu resuscitator 1

Sucket, mobile, stainless steel 1 IV Stand 1 Mayo stand 1 k 0xygen resuscitator, wall-mounted 2 l

l l Resuscitator, manual 1 ,

l l

, ,+, --- - -., - n.- - - , . . . , , - ,,--.,,.-n,v-..., ,,.n-_.,,,.,.,_,,,,---,n,,..n,,-n,,,,_,-,._,._-_,_-.n_n,-,,- -

--,,,,-,_,_n-., ,.w,.,,-.-,-.

. June, 1984 ,

k '

N

-3 i

ITEM OUANTITY Sphygmomanometer, well-mounted 2 Surgical lamp, ceiling-mounted 1 I

e i Waste receptacle, metal 1 Gurney 1 Clock, wall-mounted 1 i

CLOTHINC/ LINEN SUPPLIES Apron, plastic, box 1 i

cloves, surgeon's sufficient i

Protective Clothing Packs: (RMC type) 12 Aprons (2) e Cap (1)

Cloves, surgeon's (2) pr Cowns (2) t' (1)

Mask Shoe covers, yellow (1) pr plastic MEDICAL SUPPLIES:

5 Specimen storage container l.

4 I

I

I I

Revision: 4 March, 1984 1

1 O

e t

L 1

ATTACRMENF H RADIATION EMERGENCY TELEPHONE DIRECTORY e

o O

O S

. - - > - ,-,----,.,.-,,----n - ., -- .,-m,, ---,m-.,,,--... . ,. ..-. --,,,e,,,.-,,,,,,_n

l HeV1510n: b June, 1984 ATTACHMENT H RADIATION EMERGENCY TELEPHONE DIRECTORY Salem County Memorial Hospital Day Night Emergency Room 609-935-1000 Ext. 231 J. Michael Galvin 609-925-1000 Ext. 201 609-299-0079 President Alberta' Clour, R.N. 609-935-1000 Ext. 255 609-935-6515 Vice President / Nursing or 379 i Joanne Brodrick, R.N. 609-935-1000 Ext. 246 609-468-5496 In service Education Coordinator William L. Wilson 609-935-1000 Ext. 324 609-935-2047 Director, Plant Operations 1

, Paul Fredricks 609-935-1000 Ext. 207 609-678-3654 Sr. Vice President Lawrence B. Owen, M.D. 609-935-1000 Ext. 326 609-678-3212 ,

Chief of Staff .

O v Public Service Electric & Gas Company, 80 Park Place, Newark, NJ 07101 Bernard Reilly, M.D. 201-430-5930 201-744-2476 Medical Director Ronald J. Mack, M.D. 201-430-5939 201-773-9235 Manager of Dispensaries Assistant Medical Director Coordinating Physicians John R. Castiglioni, D.O. 609-935-1000 Ext. 231 609-769-3152 Gordon J. Ostrum, M.D. 609-769-0226 609-769-0460 2

Lawrence B. Owen 609-935-1000 Ext. 326 609-769-3212 Chief of Staff ,

John Madara, M.D. 609-935-1477 609-935-2220 31 Market Street Salem, NJ 08079 O

e H-1

--_-._--,----,..,..,_-,~_.,,__.,-,..,,_,m .,,,y%,.c_,,,,,_~m-y., .,.,r_.._.--__.. ,,,-y. .m---. ,,,.,.-,--_~--,%--.v,,.,.---

Revision: 4 March, 1984 ATTACHMENT H (Continued)

RADIATION EMERGENCY TELEPHONE DIRECTORY (Continued)

I Day Ni g h_t_

Ambulance Service Lower Alloways Creek Ambulance 609-935-4222 (General Bus.) 609-935-4505 (Emer. #)

Elsinboro Fire & Rescue 609-935-2814 609-935-2814 Norman Davis, EMT Coordinator 609-935-1000 Ext. 304 609-769-0818 Woodstown Ambulance / Rescue Salem Nuclear Generating Station John Zupko 609-935-6000 Ext. 4300 Plant Manager Jim O'Connor 609-935-6000 Ext. 4645 Radiatien Protection En9 neer 1

Paul Eldreth 609-935-6000 Ext. 4572 Nuclear Fire & Safety Engineer Pete Moeller 609-935-6000 Ext. 4400 609-463-4737 Manager, Site Protection .

Wayne L. Britz 609-935-6000 Ext. 4546 609-935-4334

,0s Manager, Radiation Protection Services Radiation Management Corporation Emergency: PRIMARY 215-243-2990 SECONDARY 215-841-5141 GENERAL BUSINESS 215-243-2950(Philadelphia) 312-291-1030(Chicago)

H-2 -

4 Revision: :3 March, 1984 i

e 4

P i

ATTACHMENT I LOCATION OF MANUALS 0

g

.I I

l I

I

\

e b

g4

Revision: 5 s August, 1984

\/ ATTACHMENT I LOCATION OF MANUALS Manual Number Loca tion Radiation Management Corporation Il Philadelphia Office Salem Nuclear Generating ' Station 2 Manager, Radiation Protection Services 3 EOF Locker 4 Radiation Protection Engineer 5 Nuclear Department. Safety Supervisor 6 First Aid Room 7 Security Emergency Locker Salem County Memorial Hospital

. 8 President 9 Senior Vice President O,- 10 Radiation Emergency Area 11 Vice President / Nursing 12 Nursing Supervisor 13 In Service Education Coordinator 14 Chief of Staff 17 Radiology 10 Plant Operations Director i Coordinating Physicians l

15 Gordon J. Ostrum, M.D.

Public Service Electric & Gas Canpany 16 Medical Director 19 Assistant tiedical Director 1

I-1

-r, --- - , - - - - - . -,,,_,,,,,,---.nn.-,n._,

_ , , . _ . , . - _ _ , - . . - , , - - , _ , , , , . - ,n ,-,,. , ,n -, ,.r. ,-,,. ,. _n,.,. , , , - .

Revision: 0 December, 1982

. O l

ATTACHMENT J PERSONNEL DOSIMETRY LOG AND PATIENT DATA SHEETS 4

9 O

1 I  :

O

, ---n . ~ . _ . , _ , - ~ - . . . . _ _ . . _ _ _ _ _ . , . _ , - , , - - , , , . . , , _ , . , . _ , . , _ , ,

_m December, 1982 w

Cr W

E

,v ,)

\

oc "a W C er EM Mm e ar-W -

CE E 'r' W C

. Ch. M C'

W W

.ZW WE CL. M m

8 H

W%

• M UO

• C &

S Qc M C EC 8 MJ K&

d

=

5 W -

E !E W k a m m

m M

G) H L. H 34 W 9 E fu H M CZ H CD o-*

N eO W m Ch.

H J Q b

, E O

U w

m" (JD'l 8

m -

J-1

ReMN O INDICATE CONTAMINATED AREAS AS TO TACATION, December, DEGREE 1937 OF CONTAMINATION, DECON EFFORT 6

INDICATE 1hCAT10N OF WOUNDS

<f

' Q

) ) s .,

.E' l

2 D**

c s hA / '%

g.

,/

a f

f--[5 I*') ,( ,

- *g '

I i' i.

~o es.t.4,.Mn '

de

• % e *G.

t s

}.r .:

s l

.. f- k(

i a

if -

\

t -

@ I

\ f Y, O

m..

[

\l ,

. . k .

• ~

TYPE OF METER USED:Nel and number)

, ~

fne M DISTANCE SKIN TO FROBE:

J-2

.-..- :--.-.-._ -.-..~_. .....- - - . . . _ . - . . . . -

e 7

l 4

ENCLOSURS 4 w- - - . , - . . . - . - - . , . __ . - _ - _ _ _ _ . _ _ . _ _ . . - , . . , .

ACCOUNTABIUTY' STATIONS CASUAL VISITORS GUIDE

@ Administration Office ARTIFICI AL ISLAND

@ Cafeteria i , ,

f @ Service Bldg. Control Point ]

@ OSC

@ "A" Bldg. Control Point s g SALEM NUCLEAR DEPARTMENT

@ Change House READ THE FOLLOWING MATERIAL l ,sm ,,,_,

u

[. KEEP IN YOUR POSSESSION WHILE AT STATION

1. Visitors require escorts at all times. In case of w #5 I an emergency report with your escort to his/her

, g accountability station, p -

C" '" 2. Radiation Controlled Areas (RCA) are posted j _ 3 2

,i with yellow and purple waming signs. Do not

__ enter an RCA without first receiving training on l ~

C""** the risk of radiation exposure to the human

_ body.(Reg. Guide 8.29) and the Federal Limits established for radiation exposure to the human body (10CFR20).

l

% 3. While at the Salem Nuclear Generating Station you hear many alarms.

Listed below are the alarms and your response to these alarms.

]

!, FIRE ALARM Coded beeping tone over PA system.

p Rotating red beacons in high oise areas.

cc h co a- Response:

3 Remain where you are if safe unless otherwise directed by the

~ ~'~ 84 4 Senior Shift Supervisor.

{ _

in high noise areas proceed to nearest Page Station for direction.

4 RADIATION ALERT ALARM g Short pulse cycling siren over PA system.

ja Rotating yellow beacons in containment.

5 # 8* Response:

Remain where you are unless directed to evacuate the area by the l SaIem S*de Senior Shift Supervisor or Radiation Protection Supesvisory personnel In high noise areas proceed to nearest Page Station for direction.

a s. . .

CONTAINMENT EVACUATION ALARM GENERAL EMERGENCY INSTRUCTIONS Long pulse cycling siren over PA system.

Rotating yellow beacons in containment. Personal Accountability A. Gamanni. RuLas Response: 1. Tar un.oa nuo= af raca accouna. un n* Tion wu amu == cont =oL or THE AssEM. leo GRou,.

All personnel in containment leave immediately. lf possible 2. Toose mmviounts ass ..uo w,u n.am o. ..Lv a .. ,=,ano To

. #ECEevE ANo CAA8tv ouf FuRTHER $NsTRuCTeoNs.

evacuate through same hatch used to enter contamment. 3.oo ofun m ,p.u,,un ,o.a.,.. . cv.

Report to appropriate Control Point. " ca" " "5 """ acc*uma*'u":

8 '".1 "RaronT To youn ossa.NaTE. ACCouMTa.iuTV sTaf tons.

Other personnel remain at Qork unless otherwise directed a. ir - a com ouso Accru Ana. = con To me ....o man con.oi.

P by the Control Room via the PA system. ,, ,,

',",,',,,o . s .o u = con To me osc.

c. Raoimison Pnotection nacoat To Tus stavecs Buetomo Cominos. PomT.

o. Cos micat aNo sacatransat censoNNEL REcoRT To CLERICAL of r8CE.

FUEL HANDLING BUILDING EVACUATION ALARM Ao.. n u o Bu.to ..

s. An oTHen PsE&G esorte. atro=7 to me Carrvema.

Long pulse cycling siren in FHB and outside areas im- r. Outs'or couaacion w m Tra no) on won noeu wu wron To mem "sTa= or wonu" Location (s.o. - cua,.oc wouse) mediate to the build.in g. a. ouis,o, co,,T acToo w,m u n ma, ,o no3 wo,u = ,o= To m.

Local alarm lights next to FHB entrances. c^" " "'a-Response: Fire A. Gentnat Ruus All personnel in fuel handling building leave immediately. 1. Fouow cooo woussuurmo enacrects.

2. Eummava FLamma.La LEaxs on seeLLs as ousenty as THav occ'Ja.

Report to appropriate Control Po.m t. 3. oo noT o.n.uct ,assaceways o. r e cou,,.. T.

Other personnel remain at work unless otherwise directed 4 "" " a aa ' c '*" a u" ** **oa ^*'aov^' ** * a 'a a^'s -

5. Use rene reswis a sovere0ENT of.LV roft ITs INTENoEo usE.

by the Control Room via the PA system. s. suona oNLv = n==.nco anas.

B. la case or rues:

1. souno Twe =AnssT rene atanu.

CARDOX FIRE PROTECTION SYSTEM ALARM 2. cau == com.ot Roo . ext. so22 o so2s ano nero.T LocaT o or Tw.

rsRE.

(Diesel Generators, Fuel Oil Storage EL 64, Switchgear 3. un me nu.o caos er a nue o= .s of ava a.u To co Tact me Rooms EL 84,64, Elect. Pen. EL 78) se so.n sunnv. son. DO NoT acTivaTr awv auvossafic rios sucesssion sysTE,e u Tst THE FORE .RIGaoE ARetvEs.

4. ATune,Y vo coNTAm om EXTmoutsH THE rime IN

• MANNER Cons 8 STENT wtTH YegP E -

You.a un u T u ,a.=ves.

Rotating red beacons.

Personnel Injury Response: A. Gr .at Rous

1. Hano naTs asusY .c woem as oscTano .v *LANT autas.

All personnel leave area immediately. 2. Honsa, Law is ,nons.rTro.

3. Fouow sooo ,eousence,peo enacTicas, Close all doors beh.md you to assure proper system B. i,. ca u o , n ,,so,,,,u ,,u u,,,.

operation. 1. IMMEosanLv hoTurv THE CoNTeos. Roose. ext. 3022 oe 3025 ano =,oser Location or wuumso nason. Tue swirr sunnveson wiLL oiseaTcn Twa rise.T meo Contact Control Room and inform them of system activat. ion. ma, a,.o a ut,,,c..

2. er u.aw.e m =,o.T me .uu.v. ==o me acancsuias ata==.

Do not manually activate any automatic fire supression 3. RETua s To Twa muuato nesom ano armoan aeo consasTrnv wirw vouse suTv system until the Fire Bn.gade arrives. u T mera n a,o na- a..m s.

_ m

s h

m.

B' 1

l l

l

! SALEM GENERATING STATION VISITOR CONTROL Welcome to Salem Generating Station. You have been granted escorted access to the Station. As a visitor, you are subject to the following Federally Mandated Guidelines for escorted access.

. . Violations of these guidelines may result in denialof future access l to the station. We ask your cooperation and compliance.

• Do remain with your photobadged escort at ALL times while within the Station.

• Do record each photobadged escort's badge number and the time each escort started on the reverse of your Visitor's i Request form.

• Do wear your visitor badge at chest level on your outermost

} garment.

l

• Do return your visitor's photobadge and Visitor Request form to the Badge issue Area when departing the Station.

f

• Do call Security at extension 4000 or request the nearest photo-badged passer by to escort you to the Guard !!ouse, should you find yourself without an escort

• Do during emergencies follow the instructions of your escort

• Don't be found within the Station without an escort Violation is cause for you to be escorted out of tne Station by Security.

• Don't be in violation of these rules. Denialof future access to the Station may result.

i 1 SEE REVERSE SIDE e '

I 1l m l

t F

-v,_ .,.w.-.,m _w..--sr

~

e ,

,. )

SALEM GENERATING STATION 1 VEHICLE CONTROL

1. FEDERAL REGULATIONS MANDATE VEHICLE PRIOR TO ENTERING NUCLE STATIONS. THE SEARCH IS RE0VIRED VEHICLE CONTAINS NO EXPLOSlVES, WEAPONS i DIARY DEVICES. IF YOU WISH TO DECL THIS NATURE,YOU MAY 00 SO AT THIS TIME. A SE

' THEN BE MADE OF YOUR VEHICLES AN WILL BE N0TIFIED IF EXPLOSIVES, WEAPONS OR

' DEVICES ARE FOUND.

2. STATION REGULATIONS RE0VIRE Y THE KEYS Of YOUR VEHICLE SHOULD ATTENDED AT ANY TIME WHILE WITHI UNATTENDED VEHICLES FOUND IN LOCKED BY SECURITY PERSONNEL i

SEE REVERSE SIDE i

l E g .

i f

1

• ve- . .,--,w-w-w....,y,.-_ _ _ _ - - - -

, ,- r--

ENCLOSURE 5 i

1 l

L

8 l'i 5

3 lh*!ls 3,1 1 '

,i ,, ..

~i i  ! -

ll ' I

=1.

11=i yil1l I

! 'li li pi

i. I'!i!

ih; 11

~ ,ji Idil , II I;!l I i.i II.

- i II.

i; t

T ijI l 1 lhl Lu l i I

,P,t g, a L!!a Lil jje}14ji I

i i

h' 11)!:)!!

1:'

p:

isli ,11 ,,

l. -

l ,"

il 4

11

,IlIl 1,1 i

I

1 t

j 1 i IIjil I

II in il;;l I'h,lf  !.

it .l a

a l'l 8 .

5 ll58!

lilili .

I -

,I i1i -

1., ;1 i

~

ji! - -

l _

t I <

gi l l . li 1l.1 f 8 -i . 'i Ili 1,

IIi lj

}1.Lj

, ,d 1

!!ii i!, - !1 g.

g I

I i

i ' l-l [!!!

ih

! Pi i i liljli li i -

' .l 1 l,1 8 1! I i  !

l ,i 1i 1 l l, l ri:1L r

. ii i Il,ill

,i ji:.q: i .

1 1ll i i 11h.'ll -

2 !L _ _

A sl.i '

.<!'ld' i !l1 1 '! si 1

li li,l4l, si l,

l si 1,,ji - 1 si .ii 3 1 3 lL al 1 -l 1 j ,-

la,i<!I'hli,!llil,!,.!iu ili

,i N

z ua mi. . 1:

'Nhl m

% .--- v, -

g. w ~ ~._ _ _ s-p-

.[

h f

Y L';

M

, n.

h.

i h'

ii*t N pW-=  % $4,

.' f, ,

N.

\ '

c'

-9,

v. .

ATTACHMENT 2

$g1 4

. s, s

e 4,

i% 4,.

s. . -s g,' '4

.h

• s g

( '6 , ~ .

'? (.,

=

k s

s qh  %

^

',\ b .

1 s

\ 5e

'Y s

. _.,. f

__ _ . . _ . - _ - _ _ _ _ _ . _ . _ _ _ . _ . _ . _ _ _ _ _ .