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	Initial Onsite Activities Major Goals of the Initial Response Radiation Control Zones and Perimeters Recommended by Various Agencies Radiation Response Worker Exposure Guides (PAGs) in the Early Phase Protective Action Guides for the Public for RDD and IND Incidents Personal Protective Equipment (PPE) Guidance See also: Three Phases of the Response to an RDD or IND Major Goals of the Initial Response Notify local authorities. Establish local on-site Incident Command System (OSHA) Establish perimeter security. Ensure safety of responders Identify specifics of the radiation threat, (which may not be apparent during the event discovery). Measure radiation levels in the environment Identify radioisotope(s) in the environment Notify other appropriate (local, state, federal) authorities that a radiation event may have/has occurred Identify approximate number and location of casualties Protect the public from further injury by implementing Protective Actions and Protective Action Guides appropriate for the incident. Begin triage of patients using protocols appropriate for the specific radiation event Alert local medical infrastructure to prepare for mass casualty transports Reference: Key Elements of Preparing Emergency Responders for Nuclear and Radiological Terrorism (NCRP Commentary No. 19, December 2005, purchase required; see Free Overview (PDF - 219 KB)) top of page Radiation Control Zones and Perimeters Recommended by Various Agencies Agency Zone Designation Perimeter Designation Exposure Levels Activities and Guidelines IAEA† (See diagram) --- --- >10,000 mR/hr (>10 R/hr) Only lifesaving actions should be performed Limit staying time to <30 minutes Inner Cordoned Area Safety Perimeter >10 mR/hr - OR - 1000 Bq/cm2 β, γ surface contamination - OR - 100 Bq/cm2 a surface contamination Inner cordoned area: area around dangerous radioactive source where precautions should be taken to protect the responders and the public from potential external exposure and contamination. "Forensic evidence management area" should be located in the inner cordoned area, adjacent to the "safety access" and "contamination control area". "Response contamination control area" should be located at the boundary of the inner cordoned area and away from the public processing area. Outer Cordoned Area Security Perimeter --- Outer cordoned area: secured area around the inner cordoned area. Ambient dose rates in this area need to be at levels close to background levels. The "public processing area" should be located within the outer cordoned area with access for medical transport. The "temporary morgue area" may be located in a tent or existing facility that is secured within the outer cordoned area away froma the view of the general public. The "waste storage area" should be located within the outer cordoned area preferably in a structure that is secured and positioned to prevent the spread of contamination (e.g., by wind or rain). The "Incident Command Post" should be established outside the outer cordoned area. NCRP‡ (See diagram) --- Inner Perimeter 10,000 mR/hr (10 R/hr) Actions taken in this area should be restricted to time sensitive, mission critical activities such as life saving. --- Outer Perimeter 10 mR/hr - OR - 1000 Bq/cm2 β, γ surface contamination - OR - 100 Bq/cm2 a surface contamination Appropriate actions are to Evacuate members of the public Isolate the area Minimize time each emergency worker spends inside the area Ensure that workers follow appropriate personal protection guidelines. --- --- --- The area outside the outer perimeter is where the command post and other support functions are located. To implement the ALARA principle, the selection of locations for decontamination as well as for staging equipment and support personnel should be made carefully, and if possible, these functions should be established in areas without elevated exposure rates. CRCPD§ (See diagram) Extreme Caution Radiation Zone Extreme Caution Radiation Boundary ≥10,000 mR/hr (10 R/hr) Activities restricted to saving lives. Total accumulated stay time for first 12 hours: minutes to hours High Radiation Zone High Radiation Boundary 1000 mR/hr Access restricted to authorized personnel performing critical tasks: Firefighting Medical assistance Rescue Extrication Other time-sensitive activities Medium Radiation Zone Medium Radiation Boundary 100 mR/hr Access restricted to authorized personnel entering the "High Radiation Zone" to perform critical tasks such as saving of lives and property. Serves as a buffer zone/transition area between the "High Radiation Zone" and "Low Radiation Zones" Low Radiation Zone Low Radiation Boundary ≤10 mR/hr Access restricted to essential individuals. Initial decontamination of first responders should occur near the "outer boundary" (i.e., "Low Radiation Boundary") of this area. † Manual for First Responders to a Radiological Emergency (PDF - 2.2 MB) (CTIF, IAEA, PAHO, WHO, October 2006) ‡ Key Elements of Preparing Emergency Responders for Nuclear and Radiological Terrorism (NCRP Commentary No. 19, December 2005, purchase required; see Free Overview (PDF - 219 KB)) § Handbook for Responding to a Radiological Dispersal Device (Dirty Bomb): First Responder's Guide: The First 12 Hours (CRCPD Publication 06-6) (PDF - 4.26 MB). Conference of Radiation Control Program Directors, Inc. Frankfort, Kentucky, 2006. Abbreviations: mR/hour: milliroentgen per hour R/hour: roentgen per hour Bq/cm2: becquerel per square centimeter a: alpha particles β: beta particles γ: gamma radiation See also: Planning Guidance for Response to a Nuclear Detonation, First edition, 1/16/2009 (PDF - 1.69 MB) (Homeland Security Council Interagency Policy Coordination Subcommittee for Preparedness and Response to Radiological and Nuclear Threats) top of page Radiation Response Worker Exposure Guides (PAGs) in the Early Phase 1-5 Explaining protective actions and guides (PAGs) | Phases of response: early, intermediate, late Total Effective Dose Equivalent (TEDE) Guideline 6 Worker Activity Condition 5 rem (0.05 Sv) All occupational exposures All reasonably achievable actions have been taken to minimize dose. 10 rem (0.1 Sv) Protecting valuable property necessary for public welfare (e.g., a power plant) All appropriate actions and controls have been implemented; however exceeding 5 rem is unavoidable. Responders have been fully informed of the risks of exposures they may experience. Dose > 5 rem is on a voluntary basis. Appropriate respiratory protection and other PPE is provided and used. Monitoring is available to project or measure dose 25 rem (0.25 Sv) Lifesaving or protection of large populations RDD incident: this dose level unlikely to be reached for response workers IND incident: this dose level is conceivable for response workers All appropriate actions and controls have been implemented; however exceeding 5 rem is unavoidable. Responders have been fully informed of the risks of exposures they may experience. Dose > 5 rem is on a voluntary basis. Appropriate respiratory protection and other PPE is provided and used. Monitoring is available to project or measure dose. 1 Adapted from Planning Guidance for Protection and Recovery Following Radiological Dispersal Device (RDD) and Improvised Nuclear Device (IND) Incidents (PDF - 394 KB) (DHS/FEMA, published in Federal Register, August 1, 2008, Z-RIN 1660-ZA02) 2 In the intermediate and late phases, standard worker protections, including the 5 rem occupational dose limit, would normally apply. 3 Other decision points for restricting response workers' activities have been recommended by various other agencies, as noted in table below. Agency Summary Information Original Document National Council on Radiation Protection and Measurement (NCRP) NCRP Radiation Protection Guidelines: Control of Radiation Dose in the Control Zones Key Elements of Preparing Emergency Responders for Nuclear and Radiological Terrorism (NCRP Commentary No. 19, December 2005, page 19, purchase required; see Free Overview (PDF - 219 KB)) International Atomic Energy Agency (IAEA) IAEA Emergency Worker Turn-back Dose Guidance Manual for First Responders to a Radiological Emergency (PDF - 2.2 MB) (CTIF, IAEA, PAHO, WHO, October 2006, page 41) Conference of Radiation Control Program Directors, Inc. (CRCPD) CRCPD Turn-back Exposure Rates and Dose Guidelines Handbook for Responding to a Radiological Dispersal Device (Dirty Bomb): First Responder's Guide: The First 12 Hours (CRCPD Publication 06-6) (PDF - 4.26 MB), page 28. Conference of Radiation Control Program Directors, Inc. Frankfort, Kentucky, 2006. International Commission on Radiological Protection (ICRP) ICRP Guidance for Occupational Exposure Protecting People Against Radiation Exposure in the Event of a Radiological Attack (International Commission on Radiological Protection, ICRP Publication 96, 2005, page 51) 4 Because each incident is unique, it is impossible to develop a single turn-back dose level for all responders in all events. Therefore, the 5, 10, and 25 rem guidelines this table should not be viewed as absolute standards applicable to the full range of incidents covered in this guidance, but rather serve as decision points for making worker protection decisions during emergencies. Incident Commanders should use the "as low as reasonably achievable (ALARA)" principle. During planning and training, managers and responders should acquire the knowledge necessary to understand the acute and chronic risks of exposure, especially at higher radiation levels. 5 By agreement with the Environmental Protection Agency (EPA), guidance in this August 1, 2008 Federal Register document will be incorporated without change into the currently ongoing revision of the 1992 EPA Manual of Protective Actions for Nuclear Incidents (the PAG Manual). This Federal Register notice of final guidance will therefore, sunset upon publication of the new EPA PAG Manual. 6 For potential doses >10 rem, special medical monitoring programs should be employed, and exposure should be tracked in terms of the unit of absorbed dose (rad) rather than TEDE (rem). See also: Personal Protective Equipment (PPE) top of page Protective Action Guides for the Public for RDD and IND Incidents1 Explaining protective actions and guides (PAGs) | Phases of response: early, intermediate, late Phase Protective action recommendation Protective action guides potentially recommended if ... Early Sheltering-in-place OR evacuation of the public2 Administration of prophylactic drugs, e.g. KI4, 6 Administration of other prophylactic or decorporation agents5 1 to 5 rem projected dose3 5 rem projected dose to child thyroid4, 6 Intermediate Relocation of the public Food interdiction Drinking water interdiction Relocation of public First year: 2 rem projected dose Subsequent years: 0.5 rem/year projected dose3 Food interdiction: 0.5 rem projected dose to any individual organ or tissue in the first year, whichever is limiting. Drinking water interdiction: 0.5 rem projected dose in the first year 1 Adapted from Planning Guidance for Protection and Recovery Following Radiological Dispersal Device (RDD) and Improvised Nuclear Device (IND) Incidents (PDF - 394 KB) (DHS/FEMA, published in Federal Register, August 1, 2008, Z-RIN 1660-ZA02) 2 Should normally begin at 1 rem. Take whatever action or combination of actions that results in the lowest exposure for the majority of the population. Sheltering may begin at lower levels if advantageous. 3 Total Effective Dose Equivalent (TEDE) 4 Provides thyroid protection from radioactive iodine only 5 For other countermeasure information see: FDA (http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm063807.htm) , CDC (http://www.bt.cdc.gov/radiation) , REAC/TS (http://www.orau.gov/reacts), and REMM countermeasures 6 FDA understands that a KI administration program that sets different projected thyroid radioactive dose thresholds (committed dose equivalent (CDE)) for treatment of different population groups may be logistically impractical to implement during a radiological emergency. If emergency planners reach this conclusion, FDA recommends that KI be administered to both children and adults at the lowest intervention threshold (i.e. > 5 rem projected internal thyroid dose in children (FDA 2001). See also: Planning Guidance for Response to a Nuclear Detonation, First edition, 1/16/2009 (PDF - 1.69 MB) (Homeland Security Council Interagency Policy Coordination Subcommittee for Preparedness and Response to Radiological and Nuclear Threats) top of page Personal Protective Equipment (PPE) Guidance PPE for First Responders when exposure hazard is unknown or uncharacterized 1, 2 Bunker gear (aka turnout gear, firefighter protective clothing, PPE Level B) Standard bunker gear Flame- and water-retardant pants and overcoat Helmet, gloves, footwear, and hood Protects against external contamination from alpha and most beta radiation, but not against exposure from high energy x-rays/gamma rays. Contaminated gear/clothing should not be worn for extended periods of time and should be disposed of per RSO guidance. Reviews of civilian PPE Levels A, B, C, D are available. 3, 4, 5 Respiratory protection Protects against inhalation of airborne toxins, including radioactive materials Basic overviews of respiratory protection equipment are available 4, 6, 7, 8, 9 Radiation monitoring equipment Survey meters Used by radiation safety team to monitor environmental radiation levels Personal dosimeters Monitors individual radiation exposure Personal dosimeter types Records cumulative dose ± preset alarm parameters Records dose rate ± preset alarm parameters Incident Managers follow Protective Active Guides regarding allowable exposure dose limits to responders. PPE for medical facility staff when hazard is known to be radioactive contamination only 10, 11 Outer wear for working in areas contaminated with radiation: PPE Level D (2, 3, 4) plus respiratory protection 3, 4, 5, 6, 7, 8 Chemical-resistant body suit (e.g., Tyvek® suit) Double layer protective gloves with inner pair and outer pair of two different colors (if possible) and gloves taped to body suit Head covering and eye/face protection (if not part of the respirator) Shoe covers or booties taped to body suit Step by step procedures for putting gear on and off Radiation Decontamination: 6 part audio-video demonstration (REAC/TS) Advanced Personal Protective Equipment (PPE) and Standard Precautions (PowerPoint® - 10 MB) (The New York City Department of Health and Mental Hygiene) Contaminated gear/clothing should not be worn for extended periods of time and should be disposed of per RSO guidance. Respiratory Protection Non-powered (negative pressure) air purifying respirator 3, 4, 6, 7, 8 Radiation monitoring equipment Survey meters Used by radiation safety team to monitor environmental radiation levels Personal dosimeters Monitors individual radiation exposure Personal dosimeter types Records cumulative dose ± preset alarm parameters Records dose rate ± preset alarm parameters Incident Managers follow Protective Active Guides regarding allowable exposure dose limits to responders. General guidance Removal of contaminated clothing from patients/victims reduces quantity of external contamination by about 75% - 90%. (See REMM suggested decontamination procedures.) Decontamination of patients/victims can greatly minimize first receivers' need for PPE. Even without PPE, first receivers have a low risk of significant injury from radioactive contamination. Pregnant women should be excluded from the care of radioactively contaminated victims, regardless of use of PPE. At the completion of each work period and any time a first responder or healthcare worker leaves the contaminated area, he/she must carefully remove personal contaminated garments, ensure that their personal dosimeter is returned to the RSO, undergo a personal radiation survey, and undergo personal decontamination if needed. PPE is not required when treating victims of radiation exposure only, as they are not contaminated. However, victims with significant radiation exposure are at increased risk of infection due to the Hematopoietic Subsyndrome of the Acute Radiation Syndrome. Universal Precautions (NYU Medical Center), usually with reverse isolation, are required to care for these patients, when they have low white counts. OSHA also provides PPE workplace guidance 12 Related REMM Information: Diagnosis and treatment of radiation contamination Decontamination Procedures Decontamination facilities Hospital zones used for decontamination Hospital zone access during a mass casualty event Radiation control zones and perimeters recommended by various agencies How to perform a Radiation survey Radiation survey equipment References from PPE Section: Protecting Emergency Responders, Volume 2: Community Views of Safety and Health Risks and Personal Protection Needs. LaTourrette T, Peterson DJ, Bartis JT, Jackson BA, Houser A. Prepared for the National Institute for Occupational Safety and Health. Rand Science and Technology Policy Institute, Santa Monica, California, 2003. Protecting Emergency Responders (HHS/CDC/NIOSH) General Description and Discussion of the Levels of Protection and Protective Gear. - 1910.120 App B (OSHA) Heubner KD, Lavonas E, Arnold JL, CBRNE - Personal Protective Equipment (eMedicine, May 23, 2006) Defining Personal Protective Equipment Levels A to D — OSHA and EPA regulations compared (Department of Veterans Affairs) Respirator Fact Sheet (HHS/CDC/NIOSH) NIOSH-Approved Disposable Particulate Respirators (Filtering Facepieces) (HHS/CDC/NIOSH) NIOSH Respirator Selection Logic 2004, NIOSH Publication No. 2005-100 (HHS/CDC/NIOSH) CBRNE Standards Development, Self Contained Breathing Apparatus (SCBA) — To Protect Emergency Responders Against CBRN Agents in Terrorist Attacks (HHS/CDC/NIOSH) Key Elements of Preparing Emergency Responders for Nuclear and Radiological Terrorism (NCRP Commentary No. 19, December 2005, purchase required; see Free Overview (PDF - 219 KB)) Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving Release of Hazardous Substances (OSHA) Safety and Health Topics: Personal Protective Equipment (PPE) (OSHA) top of page

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