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Re: Hospital/Emergency Responder response to rad hazards
Mike,
The problem with all of this is just not that
responders lack training its the standardization of the
training. The responders I have talked with all have
been trained very differently or have been short
changed on training. NYC for example has really not
trained first responders well enough. I could tell you
horror stories. With exception of NYPD ESU and NYFD
Hazmat. But they are very limited in numbers. The
Chiefs and PC cross their fingers and toes every time
we go to Orange. The individual departments, trade and
union associations and even NFPA need to standardize
the training very badly. Btw, certification of the
trainers would also not hurt.
Gerry
On Tue, 20 Jan 2004 13:08:49 -0700, Brian Rees wrote:
>
> 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
> > > > >
> > > > >
> > > >
>
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> >
>
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