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Re: Hospital/Emergency Responder response to rad hazards
> Chiefs and PC cross their fingers and toes every time
> we go to Orange
Dear colleagues,
I am really surprised with the above remark, as well the complete gerry's
topic
Jose Julio Rozental
joseroze@netvision.net.il
Israel
> Chiefs and PC cross their fingers and toes every time
> we go to Orange.
----- Original Message -----
From: "Gerry Blackwood" <gpblackwood@justice.com>
To: <brees@LANL.GOV>
Cc: <Sinclair@iema.state.il.us>; <Radsafe@list.vanderbilt.edu>
Sent: Wednesday, January 21, 2004 7:30 PM
Subject: 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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