Hospital Response to Radiological Events – Part II
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Transcript of Hospital Response to Radiological Events – Part II
Hospital Response to Radiological Events – Part II
Objective
• Discuss roles of hospital radiation advisors during radiological events
Roles of the Radiation Safety Officer (RSO)
• Preparedness• Training• Command, control,
communication• PPE• Detection• Triage
• Decontamination• Contaminated remains• Logistics• Evidence preservation• Response actions• Exercising “ the plan”
CBRNE Preparedness Planning
• Planning similar to other disasters• Unique characteristics of a radiological event• Must be familiar with local incident management
system• “All hazards approach” to disaster planning
Staff Preparedness
• Rotate staff − Reduce fatigue from PPE− Reduce overall exposure
• Limit exposure to ALARA− Regulatory limits: Annual 100 mrem vs. 5,000 mrem− Lifesaving limits never used for property
• Manage exposure and training records
Training
• Prepare for HAZMAT contaminated patient− Supplement training to include radiation safety
• Train facility-wide, tailored to the needs of hospital staff
• Use realistic scenarios• Use equipment in training
− Maintain proficiency
Command, Control, & Communications
• Accurate, timely notifications− Between event scene and hospital− Internal staff− Between hospitals involved
• Internal alarm management− Notify response personnel− Record keeping
• Media coordination
Personal Protective Equipment (PPE)
• PPE for decontamination personnel • PPE for healthcare providers• Limitations of PPE• Program management
− OSHA training− Fit testing
• Equipment maintenance
Radiological Self-Protection (For Decontamination Personnel)
• Respiratory - Particulate mask (Level C)
• Enforce time, distance, and shielding
• Dosimeter
Radiation Detection
• Recognize exposures− In patient: Information about event, ARS symptoms− In self: Detection instruments
• Purposes of detection equipment− Alert to hazards− Hazard assessment− PPE decision− Need for decontamination− Decon efficacy
Monitoring Personnel
• Person from the site: responder or patient− Quick frisk technique with pancake probe− Area monitor alerts to radiation source
• Staff monitoring− Bring hands to probe or area monitor− Frisk suspect areas by exception
Monitoring Vehicles
• Check for surface contamination− Pancake probe, slowly over each
suspect area− Vehicle exterior: Doors, tires, wheel
wells, hood, wipers (if dry)− Cab: Pedals, steering wheel, floor− Interior: Patient and crew areas− Residues from transport: Protective
covers, discarded items, and where patients lay
Monitoring Facilities
• Check for elevated radiation first (gamma probe)• Check for surface contamination (pancake probe)
− Surfaces: Anything touched or having residues− Equipment used: Handles, exposed surfaces
• Check residues before overpack− Decon site and runoff− Patient’s clothing, personal effects, etc.− Staff laundry, used PPE
Radiological Triage
• Triage:− Stabilize the patient first− Ensure ABCs− Prevent internalizing− Consider exposures later
• Segregate contaminated from not
Radiological Triage (Cont.)
Severe medical or life threatening injuries should take precedence over
decontamination!
Who Needs Decontamination?
• Decon of casualties arriving at the hospital− Already decontaminated− Home showered and laundered− Not decontaminated
• Decon of healthcare providers− Decon team members− Treating personnel − Transport and support staff
Personnel Decontamination
• Monitor/wash hot spots− Hands: Soap and water− Hair: Shampoo− Feet: Remove shoes− Clothes: Remove outer layer
• How-to− Tepid water, not hot/cold− No scrubbing!− Gently rinse− Monitor and repeat as needed
Radioactive Objects On/In Patients
• Quick scan to determine radiation hazard• Remove clothing (modestly!)
− Account for personal effects− Monitor and control items
• Irrigate wounds (if possible)
• High radiation objects− Place in tray away from others− Handle with hemostats
Decontamination of Facilities/Objects
• Protect area from contamination spread− Plastic sheeting on floor, in vehicles
• Survey instrument to locate hot spots• Wash/rinse as needed• Control runoff• Send samples to supporting rad
lab
Contaminated Human Remains
• All-hazards exposure risk− Decontamination− Containment− Refrigeration until definitive disposal
• Follow legal, medical, cultural protocols− Establish cooperative agreements for fatality
management• Secure personal effects
− Not all can be decontaminated
Logistics
• Supply priority: “Get the right stuff to the right place at the right time”
− PPE− Detection equipment distribution plan− Decontamination setup
• Equipment maintenance program− Calibration− Scheduled checks and services
Handling of Evidence
• Maintaining evidence is critical to investigation
− Clothing− Embedded objects− Decontamination runoff− Bioassay samples
• Chain of custody
EVIDENCE
Radiation Response
• Plan for who does what, when• Dosimeters: Who wears them?• Survey meters: Priority of effort
− Patients? Equipment? Facility? Vehicles? • Area monitors: Which entrances?
Remotes?
Radiation Response (cont.)
• Actions when alarms occur− Reduce personal exposure− Limit spread of contamination− Isolate danger areas− Decontaminate
Example Area Alarm Response
• Security acknowledges alarm− Stop offender, divert to safe area
• Questions to investigate alarm− Receive any nuclear medical procedure?− Anyone close receive same?− Work with radioactive materials?− Involved in bombing or suspicious incident?− Where were they last?/Why come to hospital?
• Follow up as needed
Exercise the Plan
• Start small, few casualties, simple problems• Be realistic—but only as needed
− Safely handle radioactive sources• Coordinate with other agencies/hospitals• Exercise with all hazards approach
Tabletop Exercise Guidelines
• Define reasonable objectives• Basic scenario to address objectives• Who should/could participate
− What level of involvement: Responder? Executive? • What point to start and stop play
− Limit actions to discussion (not actually done)• How much is presented to players
− Prepared handouts or presentation graphics• Facilitator keep on track and on schedule
Example Tabletop Scenarios
• Person enters and sets off alarm− Front door vs. ED− Nuisance vs. actual alarm
• Ambulance inbound with reported “hot” patient− Vary type and extent of contamination
• Radiation survey discovers contamination− During a radiation event vs. routine check− In the ED vs. foyer− In an ambulance
Key Points
• Plan and train for radiological events using all hazards approach
• Use these materials to prepare instruction for hospital staff
− Basic or advanced radiation safety− Operate and maintain each instrument− Round-table discussion of risk mitigation