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	You are here: Home > Hospital Staff		Help on REMM New Users: Where Do I Start? What's New on REMM? (12/2012) Multimedia Library Tools Download REMM (12/2012) Download Mobile REMM (12/2012) Dictionary Emergency Contacts Dose Estimator for Exposure Scarce Resources Triage Tool Manage ARS Subsyndromes Print Algorithms & Tables Diagnosis & Treatment Patient Management Algorithms Acute Radiation Syndrome (ARS) Hematopoietic Subsyndrome Cutaneous Radiation Syndrome Time/Dose Effects in ARS Time Phases of ARS Isotopes of Interest Countermeasures: Internal Contamination Countermeasures: Exposure Decontamination Procedures Strategic National Stockpile    Population Monitoring and Radionuclide Decorporation Following a Radiological or Nuclear Incident (NCRP Report No. 166, 2011) Nuclear Detonation Scarce Resources Working Group Publications, 3/2011 (HHS/ASPR) Response to a Nuclear Detonation: State and Local Medical Planners Playbook, 3/2011 (HHS/ASPR) Responding to a Radiological or Nuclear Terrorism Incident: A Guide for Decision Makers (NCRP Report No. 165, 2010) Management of Persons Contaminated With Radionuclides: Handbook (NCRP Report No. 161, Vol. I, 2008) Planning Guidance for Response to a Nuclear Detonation, 2nd Ed, 6/2010 (National Security Staff)    AFRRI AHRQ CDC CRCPD DHS DOE EPA FDA HHS HPS IAEA   ICRP NACCHO NARR NCRP NRC OSHA REAC/TS RERF RITN UNSCEAR WHO
	Hospital Staff Planning guidance documents Planning for radiation-specific hospital activities Radiation issues at hospitals Crisis standards of care Incident Command System and Hospital Incident Command System Clinical management of radiation injury issues REMM tools for hospitals References top of page Planning guidance documents Response planning top of page Planning for radiation-specific hospital activities Notify authorities: Radiation Emergency Contacts List Create a hospital radiation response team Create an hospital response plan Plan for surge in patient numbers Equip the ED for a radiation emergency Understand radiation countermeasures For exposure For internal contamination top of page Radiation issues at hospitals For staff Badge by name and function Engage radiation safety personnel Implement worker exposure guidelines, including those for pregnant workers Assign radiation survey meters, PPE and dosimeters to staff who need them Accessible, in working order, with prior training on how to use Implement perimeter security and internal hospital security Minimize and manage hospital contamination if it occurs How to identify contamination How to perform decontamination Where to locate the decontamination facility Instruct medical staff and housekeeping about management of contaminated waste How to handle radioactive water in runoff Implement emergency triage procedures consistent with the radiation hazard Communicate With other responders With the public Engage Public Information Officers Fatality management for deceased with contamination and/or exposure Training Formal drills and exercises involving radiation emergencies ICS and HICS Agreements for resources sharing with local/regional authorities should be established in advance Understand potential scarce resource issues Plan for how/when standards of care will change from "normal" to "contingency" or "crisis" Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report, (NAS/IOM, National Academies Press, 2009) IOM has provided updated recommendations in 2012. AHRQ has also provided guidance about implementation on this topic. Manage ARS with Scarce Resources after an IND Understand access to the Strategic National Stockpile For visitors and patients Detect contamination at entrance areas Develop policy for managing contaminated locations and persons Keep track of all who enter including patients and visitors during the event, with wrist banding and database Develop policy for long term follow-up Patient handling flow in the ED: illustration top of page Crisis standards of care Crisis Standards of Care (CSC): A Systems Framework for Catastrophic Disaster Response (Institute of Medicine, March 21, 2012) Volume I: Introduction and CSC Framework Volume 2: State and Local Government Volume 3: EMS Volume 4: Hospital Volume 5: Alternate Care System Volume 6: Public Engagement Volume 7: Appendices Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations, a Letter Report (Institute of Medicine of the National Academies, September 24, 2009). Allocation of Scarce Resources During Mass Casualty Events (HHS/AHRQ, June 2012) (This report represents follow-up after the 2009 IOM report.) top of page Incident Command System and Hospital Incident Command System Incident Command System (ICS) Hospital Incident Command System (HICS) top of page Clinical management of radiation injury issues Clinical algorithms Combined injury Mass casualty issues At-risk and special needs patients and visitors Use of blood products Plan surgery before neutropenia Consider consultation with the Radiation Injury Treatment Network Acute radiation syndrome Hematological subsyndrome Cutaneous syndrome top of page REMM tools for hospitals Template for adult/pediatric orders Clinical algorithms Biodosimetry tools Medical countermeasures for managing radiation exposure Medical countermeasures for managing internal contamination Follow-up instructions Formal drills and exercises top of page References HHS Medical Surge Capacity and Capability: the healthcare coalition in emergency response and recovery (HHS, 2009) Medical Surge Capacity and Capability (MSCC): a management system for integrating medical and health resources during large-scale emergencies, Second Edition (HHS 2007) Hospital Preparedness Program (HHS grant program) Hospital Preparedness Exercises Resources (HHS/AHRQ, Dec, 2010) Preparedness for Chemical, Biological, Radiological, Nuclear, and Explosive Events: Questionnaire for Health Care Facilities (HHS/AHRQ, 2007) Training of Hospital Staff to Respond to a Mass Casualty Incident (Evidence report/technical assessment number 95, AHRQ Publication No. 04-E015-2, July 2004) Other Assessing Medical Preparedness to Respond to a Terrorist Nuclear Event. Workshop Report. (Institute of Medicine of the National Academies. June 15, 2009. Purchase required.) Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report, (NAS/IOM, National Academies Press, 2009) Proceedings for the National Symposium on Hospital Disaster Readiness (American Hospital Association, February 2002) Responding to a Radiological or Nuclear Terrorism Incident: A Guide for Decision Makers (NCRP Report No. 165, National Council on Radiation Protection and Measurements, Bethesda, MD, 2010) Developing Radiation Emergency Plans for Academic, Medical or Industrial Facilities (NCRP Report No. 111), National Council on Radiation Protection and Measurements, Bethesda, MD, 1991. Dainiak N, Delli Carpini D, Bohan M, Werdmann M, Wilds E, Barlow A, Beck C, Cheng D, Daly N, Glazer P, Mas P, Nath R, Piontek G, Price K, Albanese J, Roberts K, Salner AL, Rockwell S. Development of a statewide hospital plan for radiologic emergencies. Int J Radiat Oncol Biol Phys. 2006 May 1;65(1):16-24 [PubMed Citation] Patient Decontamination: Recommendations for Hospitals (PDF - 124 K) (The Hospital and Healthcare System Disaster Interest Group and the California Emergency Medical Services Authority, July 2005, EMSA #233, Radiological Contamination, pages 11-16) Radiological Attack - Radiological Dispersal Devices (PDF - 127 KB) (The California Emergency Medical Services Authority)

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