Emergency Management Exercise/Event Critique Report. Title: Tunnel Emergency Response and Unresponsive Worker Extraction Exercise.

Transcription

1 Title: Tunnel Emergency Response and Unresponsive Worker Extraction Exercise Date: 27 May 2011 Location: Beam Switch Yard Tunnel Exercise Scope: Exercise activities were limited to the Beam Switch Yard (BSY) area located in the Tunnel, BSY Access Building 99 above ground and the road outside of the BSY Access Building. This exercise simulated an incapacitated worker in the tunnel who required medical attention along with extrication from the Accelerator Tunnel. This exercise evaluated response times as well as the effectiveness of procedures and protocols used by Accelerator Operations, Guards, Occupational Medicine and Public Affairs to respond to, coordinate and interact with the Newport News Fire & Rescue department during an emergency exercise at Jefferson Lab. Additionally, completion of the exercise fulfills the annual exercise requirement for Thomas Jefferson National Accelerator Facility (TJNAF) as required by Department of Energy (DOE) O 151.1C, Comprehensive Emergency Management System. Critique Members: Accelerator Operation Safety Coordinator (Exercise Controller) Jefferson Lab Emergency Manager Radiation Control Group Environmental Monitoring Engineer Occupational Health Nurse Public Affairs Specialist DOE Site Office Representative Background: A Tunnel worker while trying to cross over a beam line crossover point, slipped, fell and hit his/her head rendering them unresponsive. A passing coworker noticed the unresponsive worker and immediately went into action, thus starting the exercise. There was no simulation of the fall, and no props were used to simulate blood or any other bodily fluids. Event Timeline: 09:58 Simulated victim on Tunnel Floor 10:03 Exercise/Evaluation Start 10:15 Internal Emergency Responders Arrive at Scene 10:18 Outside Emergency Responders Arrive at Scene 10:38 Victim out of Tunnel and into Emergency Vehicle for offsite transport 10:38 Exercise Finish 10:50 Internal Emergency Responders Depart Scene 11:04 Outside Emergency Responders Depart Scene 11:10 Post Exercise Critique Start 11:45 Post Exercise Critique End

2 Feedback/Suggestions to include CATS number if needed: o Ensure the phone/computer read out displays after 911 calls are placed display the building name along with the appropriate building number for ease of location communication. o Pages to staff regarding 911 calls should include the building name and number for prompt information dissemination. o It was not clear from the pages sent out if the 911 call was made from the tunnel or upstairs. This should be very specific to ensure prompt information dissemination. o It was not initially clear what the nature of the 911 call was for. More information in the page needs to be given in order to ensure adequate and appropriate response. o Guards should update procedure to contact JLAB Fire Protection Engineer after 911 calls. o Occupational medicine was the first to arrive but waited until they could be escorted into the tunnel. Occupational Medicine personnel should have sufficient training to enter any location as rapidly as possible to eliminate unnecessary waiting and reduce time between incident and patient care. o Newport News Fire and Rescue had a difficult time knowing who to talk to for information. Recommend some kind of hat or vest to be worn by JLab Incident Commander which clearly identifies them. o Several calls were made to the initial 911 call (x5216) by the guard with no answer. It was later determined that several phones within the tunnel were either inoperable or worked sporadically. An Atlis is always entered at the beginning of the Scheduled Accelerator Down (SAD) periods for a general search and repair of telecomm issues. However this request has not been down fulfilled. Recommend a shift of priorities so that a thorough search and replacement of all inoperable phones can be done in a timely fashion. o Accelerator Operations procedures state to carry supplemental dosimetry to the 911 call area for distribution to the responders. However, it is unclear as to who should be given these dosimeters (i.e. OccMed, NNFD, NNPD, etc.) Assumptions were made that OccMed is trained and carries their own dosimetry. This is not the case and they too should have been given dosimetry before entry. o In Accelerator Procedures, there is no clear guidance how to respond during long term downs which delayed response times. General Conclusions & Specific Lessons Learned: 1. The exercise seemed to go as planned and various issues were identified for improvement. However, at the beginning of the planning stages of the exercise, it was unclear to the planning committee what needed to be tested and how broad the involvement should be. A predetermined scope would have helped the committee to understand all the objectives needing to be covered. 2. The Guard and Accelerator Operations procedures are well thought out, though not strictly adhered to or followed during this exercise. Conducting more procedure targeted exercises/drills/tabletops during the year would help with adherence. 3. It was noted in the post exercise review that there was too much going on during the exercise for the observers to take in. Using additional observers at each location being observed would help capture all aspects of the exercise. 4. There was an issue with responders understanding who the Incident Commander (IC) was, which hampered communication flow. Additionally, the IC should be trained and

3 5. easily identifiable to outside and inside responders at the scenes (identifiable hat, vest, etc.) 6. The main lesson was that we need more practice in order for responders to remain level headed under pressure. Event Photos: NNFD Engine 6 parked at building 98 which is next to building 99 (Access for BSY Tunnel) NNFD Ambulance 6 at building 99. Top Guard vehicle is parked to the side of building 98 and next to Ambulance 6. NN Fire & Rescue working on JLab victim? As NN Fire & Rescue work, Exercise Observer and Mobile Guard look on

4 Loading Jlab victim into NN Ambulance 6 NN Fire & Rescue removing victim from BSY Exercise Controller and Crew Chief with NN Fire & Rescue discussing exercise highlights

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6 DOCUMENT INFORMATION 1. This exercise plan contains scenario information and is not to be shared with the players prior to the exercise. 2. The point of contact for this exercise is: Harry Fanning Accelerator Safety Coordinator (757) Evaluators for this exercise: Mike Epps, Thomas Jefferson Site Office Tina Menefee, Emergency Manager Harry Fanning, Accelerator Safety Coordinator Gina Dixon, Radiation Control Group Environmental Monitoring Engineer Joane Newman, Occupational Health Nurse Kandice Carter, Public Affairs 4. The controller for the exercise is Harry Fanning. The controller s role: Keep the exercise focused on the exercise objectives Provide injects as required according to the event checklist. Acronym/Abbreviation ADIC BSY DOE ESH&Q IC LCW MCC NNFD OccMed OSP OPS PPE SAD THA TJNAF GLOSSARY OF TERMS Term Associate Director In Charge Beam Switch Yard Department of Energy Environmental, Safety, Health & Quality Incident Commander Low Conductivity Water Machine Control Center Newport News Fire Department Occupational Medicine Operating Safety Procedure Operations Group Personal Protective Equipment Scheduled Accelerator Down Task Hazard Analysis Thomas Jefferson National Accelerator Facility 1.0 GENERAL INFORMATION 1.1 Purpose This exercise is to evaluate response times as well as the effectiveness of procedures and protocols used by Accelerator Operations, Guards, Occupational Medicine and Public Affairs to respond to, coordinate and interact with the Newport News Fire & Rescue department during an

7 emergency exercise at Jefferson Lab. Additionally, completion of the exercise fulfills the annual exercise requirement for Thomas Jefferson National Accelerator Facility (TJNAF) as required by Department of Energy (DOE) O 151.1C, Comprehensive Emergency Management System. A secondary purpose is to familiarize the off-site Newport News Fire & Rescue department with our facility providing them experience in extricating a simulated victim from JLab s tunnel. 1.2 Scope Exercise activities were limited to the Beam Switch Yard (BSY) Tunnel, BSY Access Building and road outside of the BSY Access Building. Laboratory Organizations Accelerator Response Team JLab Security (Top Guard) Occupational Medicine Off Site Medical Assistance (NNFD) Public Affairs Accident victim Level of Participation Full Full Full Full Simulated/Partial Simulated 1.3 Scenario Narrative Scenario information should not be shared with the exercise participants Preexisting Conditions It is 10:00 am on May 27, The Accelerator is in a Scheduled Accelerator Down (SAD) mode so no beam is being delivered and the tunnel is open for scheduled maintenance Initiating Event A Magnet Tech is performing a follow-up inspection of a magnet in an Accelerator Tunnel segment (BSY) when they come across a pool of water coming from an LCW line feeding a magnet leading to a closer inspection. The Magnet Tech while attempting to cross over the beamline slips, hitting their head on a girder rendering them unconscious and falls to the floor face up. A secondary individual discovers the unresponsive Magnet Tech and calls for assistance. The exercise begins from this point Expected Emergency Response The secondary worker will follow standard JLab initial response protocols. First Responders (Accelerator Operations and Occupational Medicine) will follow their individual Emergency Response procedures while Security and Public Affairs will follow their standard response protocols during injury incidents Exercise Objectives The following objectives were established for the emergency response and extraction of an unresponsive worker from the Accelerator tunnel.

8 1. Given the notification of a 911 call on-site and in accordance with Accelerator Operations Emergency Response documentation 911 Call Response MCC-PR and Injury Response Flowchart MCC-PR , evaluate MCC Staff (Crew Chief and/or OPS Responder) on response times and adherence to the emergency response documentation. 2. Given the notification of a 911 call on-site and in accordance with the Emergency Incident Call & Reference Guide, evaluate Guards (at post and mobile units) on response times and adherence to the emergency response documentation. 3. Provide an opportunity for interaction between the Newport News Fire & Rescue team and JLab responders in a realistic simulation of an incapacitated worker in the Accelerator Tunnel Assumptions 1. The Magnet Tech is not contaminated by any material (radioactive or otherwise) during the exercise. 2. The Magnet Tech is wearing all appropriate PPE suited for the task they were performing. 3. All workers, first responders and security personnel have required training and that training is up to date. 1.4 Termination Conditions The following termination conditions apply to the emergency response and extraction of an unresponsive worker from the Accelerator tunnel. 1. An actual injury was to occur or simultaneous emergency occurs elsewhere at the Lab. 2. A simultaneous emergency occurs off-site which requires the full attention of the Newport News Fire & Rescue team. 3. There is no response to the simulated incapacitated worker in the tunnel.

9 Exercise Evaluator Guide Evaluator s Name: Start Time: *The initial worker is not contaminated. Time Task Met/Not Met Feedback Notes MCC -911 Response DO NOT call the number from which the 911 call was placed. (This keeps the line open for emergency response personnel) Write down the extension number, and then use "Staff" to determine the call location. Once you have the number, silence the alarm on the telephone by pressing the Critical Alert button, then the Exit button Begin monitoring Channel 6 on the 2-way radio for voice traffic that might provide information about the emergency. If the emergency is known to be injury related, refer to the Injury Response flow chart (also located in this binder) for the appropriate response Control Room personnel do the following: Start a timelog to record events as they happen. Keep the Guard (4444) informed of the situation. Contact OccMed to report any injury and ask for assistance (only during working hours) After the event has concluded, make a final ELog (and ES&H log) entry that summarizes the events and provides a timeline. Remember, DO NOT include the names of the injured in the log entry Injury Response for Found Injured Party Was 911 called? (if appropriate and not already called) Was 4444 (Guard) contacted? RESPONDER - The responder takes the following equipment: 2-way radio and MCC Operator cell phone Appropriate keys Personal dosimeter and additional dosimeters for 911 personnel (if appropriate) (they can refuse these) AED Proceed to the injury location using the best available means: foot, bike, golf cart, or car Once at the injury location, do the following: Ensure the area is safe before entering (ODH, shock hazards, radiation, chemicals, etc.) Do not move victim unless life is endangered at present location Evaluate the injury and administer first aid as appropriate (or locate other willing/trained employee to do so)

10 Communicate the situation to the Crew Chief and continue to keep him/her informed (Crew Chief may call 911 if warranted and not yet done) Direct emergency vehicles to the location (have someone remain with the victim if at all possible). If the injury location is in a Radiological Controlled area, place a dosimeter on each 911 responder (they can refuse these) If the victim is transported to a hospital, find out the intended destination (can be hard to find out after transported) Preserve the accident scene for later investigation CONTROL ROOM Control Room personnel do the following: Crew Chief assumes duties of Associate Director in Charge until relieved. Start a timelog to record events as they happen If the injury location is unknown, help coordinate the search efforts of the responder, the roving guards, and other available personnel Keep the Guard (4444) informed of the situation Call 911 if new information indicates that it is warranted and has not yet been done Contact Med. Services to report any injury and ask for assistance (only during working hours) Contact the injured person's supervisor to report the injury After the event has concluded, make a final ELog (and ES&H log) entry that summarizes the events and provides a timeline. Remember, DO NOT include the names of the injured in the log entry Guard Response Emergency Call Procedures must be followed immediately upon receiving notification of the 911 or call Upon receiving a Crisis Alert call, dispatch Post 1 and/or 3 to the scene and begin emergency call procedures by following the Emergency Call Roster and if the call is received during normal working hours Monday Friday, hours, utilizing the CIS Emergency Guard Alert Page Dispatch officers to meet emergency responders if required Message broadcast over radio: Code Blue (specify building and exact location). (x3) Dispatch the Shift Supervisor to the scene Post 1 to meet the ambulance and direct them to the exact location Notify the JLAB Security Manager and Top Guard Site and Shift Supervisor

11 Post 2 will remain in contact with the on-site officers until the incident has been closed Medical Services Response Did OccMed show up to scene? On Scene PA rep. Get notification. Determine need to go on scene w/pa manager Grab folder, get radio. Grab personal dosimeter if call comes from Accelerator Site Head to mishap location Check in with On Scene commander (NN Fire Chief) Get basic info regarding incident and report it to PA Manager. (Use cell phone or land line if possible) Nature of incident, response activities underway Ask JLab On Scene commander, what kind of access can media have to area and pass this info on to PA Manager If permitted by JLab On Scene commander and JLab EOC, escort media to approved areas Finish Time: Evaluator s signature: