[Date Prev][Date Next][Thread Prev][Thread Next][Date Index][Thread Index]
Hospital/Emergency Responder response to rad hazards
Mike,
I was involved in making a video: "Radiological Terrorism for Healthcare",
produced by Medfilms, Inc. of Tuscon AZ. It's a 13 minute video, and
geared towards most hospital workers. One of my major concerns was (and
is) that emergency personnel will be overly concerned with contamination
and exposure concerns to the point of patient harm. This has been
demonstrated in many exercises.
The video has been very well received, and continues to gather praise. One
recurring concern is that we (Dr. Fred Mettler and I) minimize the
potential harm from radioactive contamination and radiation exposure to
responders.
It's not in the video, but I'm still kicking around the idea that "if it's
still on your meter, your're safe to rescue viable victims". It's unlikely
that anyone will be carrying a meter that indicates > 1000 R/hr, and even
at 1000 R/hr a few minute rescue is well within risks that responders are
routinely exposed to. It's taken 5 minutes to get to the scene, if the
victim's still viable, a few minute rescue keeps it a rescue, and not a
recovery many 10s of minutes later. Training and talking about LD/50 fixes
that thought, and that dose becomes the dose rate of death, even though a
rescue is unlikely to take an hour. Of course, some rescues may be
lengthy, so at high dose rates it becomes that much more important to use
trained professional help in planning, but for a few minutes exposure that
rescues victims I don't see why that shouldn't be the training point. The
first incident we see that results in people dying because responders were
held back (by training, confusion, authority, etc.) will upset many people,
and probably the responders the most.
(Quite obviously) my own opinions.
Brian Rees
At 04:55 PM 1/16/2004 -0600, you wrote:
>For what it's worth:
>Back in the mid-90s, the Illinois Department of Nuclear Safety (now part of
>Illinois Emergency Management) got a flurry of queries from hospitals
>seeking ways to address JCAHO requirements that emergency rooms be able to
>handle "contaminated" victims. Finding little comprehensive material written
>for laypeople, we developed our own 40-page medical guide with a brief
>overview of radiation, the kinds of situations that might produce
>contamination/exposure, and practical advice on how to handle the victim,
>decon, contamination control, monitoring techniques, etc. The goal was
>reduce anxiety among responders and caregivers about the actual risks (or
>lack thereof) involved.
>After distributing about 1,200 copies of the original document to hospitals
>and EMS providers statewide, the "guide" became the basis for a one-hour
>in-service (PowerPoint) presentation that to date has been delivered to more
>than 2,500 hospital ER and EMS personnel throughout the state. Overall, more
>than 5,000 copies of the guide are now in distribution.
>The program, including printing, travel, etc., has not been a large expense,
>but the good will and public education return has been significant.
>Among the things we learned early on were that misinformation among EMS and
>ER staff about radiation hazards was rampant, and that those in emergency
>medicine and their counterparts in radiology and nuclear medicine weren't
>communicating. (At one large Chicago area hospital, I insisted that the ED
>supervisor and the head of Nuclear Medicine be invited to the in-service.
>They had never met.)
>Things have improved, especially after 9/11 and the interest definitely is
>there among the medical response community. If you make the information
>usable, i.e., non-technical, and you put in in the context of what providers
>already know and do, they will come.
>
>Mike Sinclair
>REP Coordinator
>Illinois Emergency Management
>
>
>
>-----Original Message-----
>From: William V Lipton [mailto:liptonw@DTEENERGY.COM]
>Sent: Thursday, January 15, 2004 6:20 AM
>To: Bradt, Clayton
>Cc: Radsafe-Digest (E-mail); 'crispy_bird@YAHOO.COM'
>Subject: Re: OSHA & Radiation (was: Badges for surgery)
>
>
>It's a good idea for a facility to provide training to local emergency
>response
>organizations, or, as a minimum, give them a tour of the facility.
>
>The opinions expressed are strictly mine.
>It's not about dose, it's about trust.
>Curies forever.
>
>Bill Lipton
>liptonw@dteenergy.com
>
>
>"Bradt, Clayton" wrote:
>
> > All NYS Labor Dept. licensees are required to notify the local police and
> > fire departments of the presence of rad material at their facility, and
> > inform them of any special emergency procedures, contact information, etc.
> > as necessary. There is even a special hazardous materials report form
>that
> > must be submitted to the fire department as well. It is up to the local
> > responding agencies to make use of the information they are given to plan
> > their response to these facilities. This is where the breakdown occurs.
> > They take the information and file it (maybe) and never follow up on it.
>If
> > the EMTs who responded to the electrocution incident had just read the
> > Emergency Response Guidebook, they would have known there was no reason to
> > balk at entering this facility. But even that level of training was
> > lacking.
> >
> > Clayton J. Bradt, CHP
> > Principal Radiophysicist
> > NYS Dept. of Labor
> > Radiological Health Unit
> > voice: (518) 457-1202
> > fax: (518) 485-7406
> > e-mail: Clayton.Bradt@labor.state.ny.us
> >
> > > -----Original Message-----
> > > From: William V Lipton [mailto:liptonw@dteenergy.com]
> > > Sent: Wednesday, January 14, 2004 11:02 AM
> > > To: Bradt, Clayton
> > > Cc: Radsafe-Digest (E-mail); 'crispy_bird@YAHOO.COM'
> > > Subject: Re: OSHA & Radiation (was: Badges for surgery)
> > >
> > >
> > > This incident shows the importance of emergency planning.
> > > Facilities which may
> > > require emergency response personnel to enter a posted area
> > > should communicate
> > > with those organizations who would respond to an emergency
> > > regarding the meaning
> > > of the posting, the expected hazards, and the appropriate
> > > protective actions.
> > > As you said, this can be a matter of life and death.
> > >
> > > It is important to train medical personnel regarding the rule
> > > that potential
> > > contamination should NEVER interfere with lifesaving medical
> > > procedures. (I had
> > > a wakeup call on this, back in 1983. We did not yet have
> > > fuel on site, but were
> > > refining our emergency plan. The site nurse told me that
> > > should would not
> > > attend to an accident victim until she was sure that he was
> > > not contaminated!
> > > We quickly corrected that misunderstanding.)
> > >
> > > The importance of training is illustrated by a medical drill,
> > > at another nuclear
> > > power plant, where I played a victim. The scenario had 2
> > > victims: me - heavily
> > > contaminated, only slightly hurt, other victim - slight
> > > contamination, seriously
> > > injured. I was also instructed to make a lot of noise. (A
> > > scene was recorded
> > > on the video of the Nuclear Shift Supervisor telling me to
> > > "Shut the **** up.")
> > > The responders did a good job, although, in retrospect, I
> > > received too much
> > > attention and the seriously injured victim not enough. The
> > > ambulance drivers
> > > took the whole thing a little too seriously. I was scared,
> > > for real, when they
> > > drove the ambulance at high speed through a blizzard.
> > >
> > > Nuclear power plant emergency plans generally require
> > > training for offsite
> > > medical responders. It's a good idea for other facilities.
> > >
> > > The opinions expressed are strictly mine.
> > > It's not about dose, it's about trust.
> > > Curies forever.
> > >
> > > Bill Lipton
> > > liptonw@dteenergy.com
> > >
> > > "Bradt, Clayton" wrote:
> > >
> > > > John Jacobus wrote:
> > > >
> > > > "And when was the last (or first) time OSHA inspected a
> > > > hospital? We had an overexposure at our cyclotron
> > > > facility, and OSHA did not respond even when we
> > > > contacted them. We are a federal agency, and do not
> > > > come under state regulations. I assume a state agency
> > > > would have been interested."
> > > >
> > > > We had a near electrocution at a cyclotron facility not too
> > > long ago. OSHA
> > > > investigated that incident, but radiation exposure wasn't
> > > an issue. OSHA
> > > > has very few people with any radiation background. This of
> > > course does not
> > > > prevent them from claiming that they regulate in the area
> > > of radiation
> > > > hazards from x-ray and non-AEA materials. They want the
> > > turf but won't
> > > > invest in the personnel to do the job.
> > > >
> > > > With regard to the electrocution incident: We have had a
> > > running battle with
> > > > local code enforcement people in some municipalities who
> > > insist on requiring
> > > > posting on the outside of all buildings where radioactive
> > > materials are
> > > > stored/used - regardless of the form or quantities. (For
> > > the protection of
> > > > first responders, they claim.) The cyclotron facility was
> > > located in one
> > > > such municipality, and had a radiation sign on the outside
> > > of the building.
> > > > When the EMTs arrived, they at first refused to enter
> > > because of the sign.
> > > > Meanwhile the victim was unconscious on the floor and the
> > > pharmacist was
> > > > yelling and cursing at the EMTs to get them to come in to
> > > treat him. They
> > > > finally overcame their radiophobia and the individual was
> > > transported to
> > > > hospital. The victim recovered but had some severe burns.
> > > Here again we
> > > > have an agency (code enforcement this time) guarding turf
> > > in an area in
> > > > which they have no expertise. This time with near fatal
> > > consequences.
> > > >
> > > > I'm sure there is a lesson here for all of us......but I at
> > > the moment I
> > > > just can't think of what it is.
> > > >
> > > > Clayton J. Bradt, CHP
> > > > Principal Radiophysicist
> > > > NYS Dept. of Labor
> > > > Radiological Health Unit
> > > > voice: (518) 457-1202
> > > > fax: (518) 485-7406
> > > > e-mail: Clayton.Bradt@labor.state.ny.us
> > > >
> > > >
> > > **************************************************************
> > > **********
> > > > You are currently subscribed to the Radsafe mailing list. To
> > > > unsubscribe, send an e-mail to
> > > Majordomo@list.vanderbilt.edu Put the
> > > > text "unsubscribe radsafe" (no quote marks) in the body of
> > > the e-mail,
> > > > with no subject line. You can view the Radsafe archives at
> > > > http://www.vanderbilt.edu/radsafe/
> > >
>
>************************************************************************
>You are currently subscribed to the Radsafe mailing list. To
>unsubscribe, send an e-mail to Majordomo@list.vanderbilt.edu Put the
>text "unsubscribe radsafe" (no quote marks) in the body of the e-mail,
>with no subject line. You can view the Radsafe archives at
>http://www.vanderbilt.edu/radsafe/
>************************************************************************
>You are currently subscribed to the Radsafe mailing list. To
>unsubscribe, send an e-mail to Majordomo@list.vanderbilt.edu Put the
>text "unsubscribe radsafe" (no quote marks) in the body of the e-mail,
>with no subject line. You can view the Radsafe archives at
>http://www.vanderbilt.edu/radsafe/
************************************************************************
You are currently subscribed to the Radsafe mailing list. To
unsubscribe, send an e-mail to Majordomo@list.vanderbilt.edu Put the
text "unsubscribe radsafe" (no quote marks) in the body of the e-mail,
with no subject line. You can view the Radsafe archives at
http://www.vanderbilt.edu/radsafe/