Lessons Learned in Lessons Learned in Preparing for Receipt of Preparing for Receipt of

Large Numbers of Large Numbers of Contaminated IndividualsContaminated Individuals

Ken MillerKen Miller

Penn State Hershey Medical Penn State Hershey Medical CenterCenter

kmiller@psu.edukmiller@psu.edu

Alternate Decontamination Alternate Decontamination SitesSites

Alternate decontamination facilities might Alternate decontamination facilities might include school gymnasiums, fire stations, include school gymnasiums, fire stations, public meeting houses, indoor arenas, public meeting houses, indoor arenas, campgrounds, etc.campgrounds, etc.

During a recent drill HMC used an airport During a recent drill HMC used an airport hanger for handling of simulated mass hanger for handling of simulated mass casualties. Allowed effective care and casualties. Allowed effective care and treatment of over one hundred individuals treatment of over one hundred individuals per hour.per hour.

In Field Decontamination In Field Decontamination CapabilitiesCapabilities

The in field mass The in field mass decontamination decontamination capabilities may capabilities may have to be used have to be used with non-with non-ambulatory, ambulatory, contaminated contaminated individuals, as individuals, as well. well.

In Field Mass In Field Mass DecontaminationDecontamination

Mass DecontaminationMass Decontamination

Runoff Runoff Responders should closely monitor the Responders should closely monitor the

direction of runoff to prevent cross direction of runoff to prevent cross contamination between lanes and between contamination between lanes and between zones.zones.

EPA and RunoffEPA and Runoff The EPA has stated on record that they will not The EPA has stated on record that they will not

hold responders liable for run-off in a chemical hold responders liable for run-off in a chemical or biological incident caused by a terrorist or biological incident caused by a terrorist event. (Letter dated 9/17/00 from the EPA)event. (Letter dated 9/17/00 from the EPA)

Mass Decontamination Mass Decontamination WaterWater

Systematic ApproachSystematic Approach A systematic approach A systematic approach

to handling large to handling large numbers of potentially numbers of potentially contaminated individuals contaminated individuals is necessary.is necessary.

Such an approach should Such an approach should provide for surveying, provide for surveying, mass decontamination, mass decontamination, resurveying, advanced resurveying, advanced decontamination (if decontamination (if necessary), resurveying necessary), resurveying and additional and additional decontamination or ED decontamination or ED care as indicated.care as indicated.

Contamination SurveysContamination Surveys Survey with GM Survey with GM

survey meterssurvey meters Use nuclear Use nuclear

medicine and medicine and radiation therapy radiation therapy technologists technologists (familiar with use (familiar with use of instruments)of instruments)

Goal is <5 times Goal is <5 times backgroundbackground

Prepare protocol Prepare protocol for survey & for survey & documentationdocumentation

• Probe held ~ 1/2 inch from surface• Move at a rate of 1 to 2 in. per

second• Follow logical pattern• Document readings in counts per

minute (cpm)

REAC/TS

Mass Casualties, Contaminated Mass Casualties, Contaminated butbut

Uninjured People, and Self Uninjured People, and Self PresentersPresenters

DirectionsDirections

Clear directions (in Clear directions (in appropriate appropriate languages) are languages) are necessary to help necessary to help individuals individuals understand what is understand what is expected of them.expected of them.

Directions Directions

Clear directions Clear directions (in appropriate (in appropriate languages) are languages) are necessary to necessary to help individuals help individuals understand what understand what is expected of is expected of them.them.

Decontamination TentDecontamination Tent

Decontamination TentDecontamination Tent

Decontamination TentDecontamination Tent

Psychological CasualtiesPsychological Casualties Fear of radiation and misunderstanding Fear of radiation and misunderstanding

of consequencesof consequences Long term psychological effects could Long term psychological effects could

arise 48-72 hours after an incidentarise 48-72 hours after an incident Counsel on acute and potential long Counsel on acute and potential long

term physical and psychological effectsterm physical and psychological effects Psychological effects include:Psychological effects include:

Anxiety disordersAnxiety disorders Post traumatic Post traumatic stress disorderstress disorder

DepressionDepression InsomniaInsomniaTraumatic neurosisTraumatic neurosis Acute stress Acute stress

disorderdisorder

Psychological CasualtiesPsychological Casualties

Terrorist acts involving toxic agents (especially Terrorist acts involving toxic agents (especially radiation) are perceived as very threateningradiation) are perceived as very threatening

Mass casualty incidents caused by nuclear Mass casualty incidents caused by nuclear terrorism will create large numbers of worried terrorism will create large numbers of worried people who may not be injured or contaminated people who may not be injured or contaminated

Establish a center away from the ED, and if Establish a center away from the ED, and if possible, away from the hospital, to provide possible, away from the hospital, to provide psychological support to such people. psychological support to such people.

Set up a center in the hospital to provide Set up a center in the hospital to provide psychological support for staffpsychological support for staff

PreplanningPreplanning

Written Medical Radiation Emergency Written Medical Radiation Emergency PlanPlan

Assurance of appropriate supplies and Assurance of appropriate supplies and equipmentequipment

Training of personnel, including Training of personnel, including periodic drillsperiodic drills

Post drill critiques and refinement of Post drill critiques and refinement of programprogram

Preplanning for Mass Preplanning for Mass CasualtiesCasualties

Alternate plans for handling large Alternate plans for handling large numbers of contaminated numbers of contaminated individuals.individuals.

Designation of off-site Designation of off-site decontamination facility.decontamination facility.

Disaster drills.Disaster drills.

Triage SiteTriage SiteInformationInformation

Develop prepared information packets with Media Develop prepared information packets with Media Relations in advance with message for incidents Relations in advance with message for incidents involving radiation.involving radiation.

CDC website has Emergency Instructions for Individuals CDC website has Emergency Instructions for Individuals and Families titled, “FAQ About a Radiation Emergency”and Families titled, “FAQ About a Radiation Emergency”

Available in EnglishEspañolDeutschFrançaisTagalogChinese

Triage SiteTriage SiteInformationInformation

If Hospital is in Fallout ZoneIf Hospital is in Fallout Zone

Initiate environmental monitoring.Initiate environmental monitoring. Have air handling systems properly Have air handling systems properly

controlled.controlled. Prepare briefs for staff.Prepare briefs for staff. Advise Administration.Advise Administration. Move inward and downward as Move inward and downward as

indicated.indicated. Prepare for evacuation if ordered.Prepare for evacuation if ordered.