Preplanning
National Response Plan |
|
|
top of page
|
National Planning Scenarios |
- National Planning Scenarios — created for use in national, federal, state, and local homeland security preparedness activities (PDF - 3.04 MB) (DHS, Version 20.1 Draft, April, 2005)
- See Scenario 1: Nuclear Detonation — 10-Kiloton Improvised
Nuclear Device
- See Scenario 11: Radiological Attack — Radiological Dispersal Devices
|
top of page
|
International Reponse Plan |
|
|
top of page
|
Understand Hospital Incident Command System |
|
|
top of page
|
Develop a Radiation Preparedness Program
 D
Adapted from Dainiak N et al. Development of a statewide hospital plan for radiologic emergencies. Int J Radiat Oncol Biol Phys. 2006 May 1;65(1):16-24. [PubMed Citation]
See also: Becker, SM Emergency Communication and Information Issues in Terrorism Events Involving Radioactive Materials. Biosecurity and Bioterrorism. 2004;2(3): 195-207.[PubMed
Citation]
|
top of page
|
Develop a Hospital Medical Response Team
Adapted from Dainiak N et al. Development of a statewide hospital plan for radiologic emergencies. Int J Radiat Oncol Biol Phys. 2006 May 1;65(1):16-24. [PubMed Citation]
Radiological Emergency Medical Response Team Members
| Role |
Responsibilities |
|---|
| Radiation safety officer |
- Primary individual responsible for radiological monitoring
- Assists emergency department and triage staff in determination of the classification of victims
- Provides guidance and preparation of decontamination space
- Directs and conducts survey, monitoring, and decontamination
- Estimates risk by measurement of dose rate,
- Documents and records all measurements
- Conveys information of dose and risk to medical caregivers
- Directs collection of blood and other biologic samples that might be required
- Considers obtaining informed consent before allowing ED staff to work in high or very high dose rate areas
- Directs monitoring radiation doses of patients and response personnel (issuing badges to all workers in moderate to high dose rate areas)
- Assesses contamination of areas used in the administration of care to patients
- Reports of level of risk to clinicians and medical caregivers
- Considers reclassifying dose rate each hour and rotating staff if indicated
|
|---|
| Emergency department personnel: physicians/nurses |
- Primary individuals responsible for the care of the patient is the emergency department medical director or, if unavailable, the emergency department physician assigned to trauma cases.
- Physician is responsible for assuring that medical and surgical care is administered in a timely and effective manner.
- Nurse is usually the primary individual responsible for initial activation of the radiation event hospital protocol is usually the emergency department nurse supervisor.
- Nurse supervisor is responsible for assuring that the various aspects of the pre-approved radiation event protocol are properly implemented.
|
|---|
| Nuclear medicine personnel |
- Assists the Radiation Safety Staff in the collection, storage, and analysis of samples, provide assistance and routine monitoring of personnel and equipment in the decontamination area
- Assists in the analysis of area and personnel contamination wipe tests, provide assistance in the monitoring of emergency transportation vehicles, and perform other duties related to radiation safety and protection, as directed by the radiation safety officer.
|
|---|
Hospital safety/security coordinator
(Administrator on call) |
- Oversees the security operation to restrict unauthorized personnel from entering the hospital radiation decontamination area or other critical areas of the hospital,
- Notifies state or federal officials if the situation requires assistance in excess of the hospital's capacity
- Assigns adequate personnel at the entrance of the hospital to restrict entry to the hospital to only those persons that are required for either operation of the hospital or implementation of the radiation disaster protocol
- Directs incoming ambulances to the proper hospital entrance as directed by the emergency department physician, radiation safety officer, or designees
- Secures the emergency medical services vehicle and prevents removal from hospital grounds until cleared by radiation safety staff, and reserves designated routes as needed.
|
|---|
| Nursing staff |
- Provides staffing in the emergency department, operating room, and elsewhere in the hospital
- Assists in decontamination, treatment, and psychological support of victims under the direction of radiation safety staff, emergency department staff, and hospital staff
|
|---|
| Physician and Allied Health specialists with relevant expertise who must be part of the response teams |
- Radiation Oncologists
- Medical Oncologists/Hematologists
- Pediatric Oncologists
- Psychiatrists
- Blood Bank personnel
- Psychologists
- Social Workers
- Trauma and Burn Care
- Pulmonary
- Toxicology
- Pharmacy
|
|---|
| Engineering/ housekeeping staff |
- Organizes and sets up decontamination area
- Provide plastic-lined waste containers and other supplies as needed in the emergency department for decontamination, with assistance from operating room personnel, radiation oncology personnel, and laboratory personnel will assist as indicated, following the radiation protocol and direction of radiation safety staff
- Will remove nonessential items of furniture from the decontamination area before arrival of the accident victims. They will participate in space clean-up as directed by radiation safety staff.
|
|---|
| Public Information Officer |
- Releases approved incident information to the public, media
|
|---|
| Security |
- Secures hospital grounds, perimeter, ED access, contaminated and uncontaminated areas of the ED, and hospital including Radiology, OR etc.
|
|---|
|
top of page
|
Equip an Emergency Department for Decontamination
- Special equipment used for the care of contaminated patients beyond the scope of the usual emergency department inventory should be kept in a storage area (i.e., cabinet) marked "Hazardous Materials Equipment."
- Adequate supplies should be stored to manage a "large disaster", with sufficient supplies to protect and assist all the personnel who are expected to participate.
- This area should be located within close proximity of the emergency department.
- The key for entering this area should be held in a secure location. An inventory list should be placed inside the cabinet. The appropriate staff person in the ED and the radiation safety team should know where this is.
- All monitoring equipment and radiation signs should be inspected and inventoried annually.
Suggested Supply List for Decontamination of Victims in the Emergency Department
| Category |
Supplies |
|---|
| Clothing |
Complete protective clothing for each member of the decontamination team:
- Tyvek® coveralls
- Surgical gloves
- Shoe coverings
- Surgical masks
- Surgical caps
|
|---|
| Detection equipment |
- Personnel dosimeters (pocket ionization type)
- Thermoluminiscent dosimeters
- Film badges
- Geiger-Mueller meters (2) - Ludlum Model #5 with pancake probe (stored in nuclear medicine department)
|
|---|
| Decontamination equipment |
- Cotton applicators
- Large plastic bags (collection of clothes)
- Adhesive tape and labels
- Large towels
- Soft scrub brushes
- Plastic sheets
- General cleansing agents: chlorine bleach, radiac wash (not to be used for patient
decontamination), soap
- Radiation warning signs
- Copy of radiation accident standard protocol
- Assorted pens
- Specimen bottles (with and without heparin and ethylenediamine tetraacetic acid)
- Kitty litter
- Emesis basins
- Fifty (50) feet of rope
- Plastic tarpaulin or other plastic coverings for the floor
|
|---|
Adapted from Dainiak N et al. Development of a statewide hospital plan for radiologic emergencies. Int J Radiat Oncol Biol Phys. 2006 May 1;65(1):16-24. [PubMed Citation]
See also: 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)
|
top of page
|
Other Information
|
- Public Health Preparedness Tools and Resources for Planning and Response (HHS/AHRQ)
- Nelson C, Lurie N, Wasserman J, Zakowski S. Conceptualizing and defining public health emergency preparedness. Am J Public Health. 2007 Apr;97 Suppl 1:S9-S11. [PubMed Citation]
- Best Practices for Hospital-based First Receivers of Victims from Mass Casualty Incidents Involving Release of Hazardous Substances (OSHA)
- Electronic Mass Casualty Assessment & Planning Scenarios (EMCAPS) (Johns Hopkins Office of Critical Event Preparedness and Response)
- Standalone disaster scenario modeling software for drill planning and education
- EMCAPS estimates casualties arising from selected biological, chemical, radiological (dirty bomb) or explosive attacks
- In a Moment's Notice: Surge Capacity in Terrorist Bombings (PDF - 6.95 MB) (HHS/CDC)
- Medical Surge Capacity and Capability: A Management System for Integrating Medical and Health Resources During Large-Scale Emergencies (PDF - 2.97 MB) (HHS/AHRQ, August 2004)
- Preparedness for Chemical, Biological, Radiological, Nuclear, and Explosive Events: Questionnaire for Health Care Facilities (HHS/AHRQ, 2007)
- Wingard JR, Leahigh AK, Confer D, Edwards J, Billups RL, van den Brink M, Keating A. Preparing for the unthinkable: emergency preparedness for the hematopoietic cell transplant program. Biol Blood Marrow Transplant. 2006 Nov;12(11):1229-38. [PubMed Citation]
- Providing Mass Medical Care with Scarce Resources: a Community Planning Guide, eds. Phillips SJ, Knebel A (HHS/AHRQ publication no. 07-001, February 2007)
- Mass Casualty Management Systems - Strategies and Guidelines for Building Health Sector Capacity (PDF - 288 KB) (WHO, 2007)
|
| |
top of page |
|
