OBJECTIVE 20: MEDICAL SERVICES - TRANSPORTATION OBJECTIVE Demnstrate the adequacy f vehicles, equipment, prcedures, and persnnel fr transprting cntaminated, injured, r expsed individuals. INTENT This bjective is derived frm -0654 which prvides that OROs shuld have the capability t transprt cntaminated, injured, r expsed individuals t medical facilities. It entails the prvisin f bth transprtatin and determinatin f the medical facility t which cntaminated, injured, r expsed individuals shuld be taken. (Treatment f cntaminated, injured, r expsed individuals in medical facilities is addressed in Objective 21, Medical Services - Facilities.) (See evaluatin criterin frm Planning Standards F.,H.,J.,L., and N.) Capabilities and prcedures relevant t this bjective are cntained in FEMA Guidance Memrandum (GM) MS-1, Medical Services. Prvisins f MS-1 apply t cntaminated, injured, r expsed individuals, including thse wh are: cntaminated; cntaminated and therwise physically injured; r expsed t high levels f radiatin. Demnstratin f this bjective fcuses n: cntrl f the spread f cntaminatin frm individuals wh may be cntaminated and injured setting f pririties between the need t address radiactive cntaminatin and need fr prmpt transprtatin t a medical facility fr an individual with an urgent medical cnditin transprtatin f such individuals t medical facilities equipped t deal with such prblems cmmunicatins with the medical facility by the vehicle crew while en rute t the medical facility mnitring and decisins n the need t decntaminate emergency vehicles after use cmpletin f activities thrugh adherence t the plan The demnstratin f this bjective fcuses n cntaminatin cntrl measures fr D.20-1 September 1991
transprted individuals, nt medical prtcls per se. The exceptin t this intent pertains t mdificatin f cntaminatin cntrl prcedures and decisins n transprtatin t a medical facility in the event that the individual has an urgent medical cnditin. While OROs may utilize licensee persnnel fr radilgical mnitring and cntaminatin cntrl functins invlved in the transprtatin f cntaminated, injured, r expsed individuals, such arrangements shuld be dcumented in ORO plans and supprted by written agreements. DEMONSTRATION CRITERIA L.4. 1. Nature and extent f external radilgical cntaminatin f an individual is determined. Explanatin Mnitring may be perfrmed by a health physics technician r by a member f the vehicle crew as prvided fr in the plan. The respnsible mnitring staff shuld demnstrate the capability t mnitr individuals fr external cntaminatin in the field prir t transprt t the medical facility, r immediately upn arrival at the medical facility. If mnitring f an individual is deferred t a medical facility, the vehicle crew shuld assume that the individual is cntaminated and use apprpriate cntaminatin cntrl prcedures. Staff respnsible fr mnitring, as stated in the ORO's plan, shuld demnstrate the prper use f equipment fr radilgical mnitring and are capable f mnitring in accrdance with the plans. The mnitring technician shuld demnstrate the prper use f an perable survey instrument(s). The instrument(s) shuld be labeled n the exterir regarding instrument respnsiveness t an identified check-surce. Instruments used fr detecting cntaminatin during the emergency phase d nt require recalibratin; hwever, they shuld be accmpanied by a radiactive check-surce that can be used in the field as a single pint calibratin check. The instrument(s) used fr mnitring shuld be prtable with a single prbe cntaining a Geiger-Mueller type radiatin detectr that prvides fr the detectin f beta plus gamma radiatin and gamma radiatin nly (e.g., a CD V-700). The minimum detectable level shuld nt be greater than 300 cunts per minute (cpm) fr beta plus gamma radiatin. (This is currently being reevaluated.) The instrument(s) shuld be equipped with earphnes r a speaker s that the technician D.20-2 September 1991
can watch the prbe while mnitring withut being distracted t read the meter indicatr. The prbe shuld be cvered with thin plastic and the beta shield shuld be pen. The purpse f the plastic cver is t easily remve any cntaminatin that might get n the prbe. A plastic thickness f ne t tw mils (e.g., a sandwich bag) will be thin enugh t avid any significant reductin in respnse frm the beta radiatin. Transparent plastic may be helpful t permit a visual determinatin f whether the beta shield n the prbe is pened r clsed; hwever, this is nt required. Prir t using an instrument(s) fr mnitring, the mnitring technician shuld demnstrate the prcess f checking the instrument(s) fr prper peratin. This invlves checking the battery status, measuring the radiatin frm the accmpanying check-surce, and cmparing the result t the prper reading stated n the label. Once the perability f the survey instrument is cnfirmed, backgrund radiatin levels shuld be determined in the immediate vicinity where individuals will be mnitred. An instrument that des nt respnd prperly t these parameters shuld nt be used. If mnitring f the individual is accmplished prir t transprt t the medical facility, the mnitring technician shuld demnstrate the capability t fllw prcedures t ensure that mnitring is accmplished in a lw-radiatin backgrund area [i.e. less than 0.1 millirentgens per hur (mr/h)]. The crew shuld demnstrate the capability t determine if the victim shuld be mved t a lw-radiatin backgrund area fr mnitring. If the simulated individual has an urgent medical cnditin, radilgical mnitring and cntaminatin cntrl measures shuld nt be undertaken if it wuld delay addressing the individual's medical cnditins. Extent f Play Under this criterin, all activities shuld be cmpleted as in an actual emergency. The individual's injuries may be indicated n an attached tag r cntrller inject. Cntaminatin f the individual r the individual's clthing shuld nt be simulated thrugh the use f lantern mantles r ther lw-level radiatin surces such as a radium dial watch. Evaluatin f decisin making regarding the setting f pririties between the need fr prmpt medical treatment and radilgical functins shuld be demnstrated thrugh an evaluatr's interview with transprtatin persnnel. L.4. 2. Emergency medical persnnel wh are respnsible fr transprting individuals frm the accident site use apprpriate cntaminatin cntrl measures. D.20-3 September 1991
Explanatin The vehicle crew shuld demnstrate the capability t fllw cntaminatin cntrl prcedures during transprt f cntaminated injured individuals. Example methds fr cntaminatin cntrl are: use f glves as prtectin against spreading cntaminatin lining f the patient area f the vehicle with a prtective cvering r wrapping the individual in a sheet r blanket cvering f the survey instrument prbe with plastic t minimize pssible cntaminatin The use f glves will prtect the hands frm cntaminatin, and remval f the glves after handling the cntaminated individual will prevent the spread f cntaminatin. Lining f the patient area f the vehicle r wrapping the patient with a sheet r blanket will help prevent cntaminatin f the vehicle and the medical facility, thereby reducing the effrt required fr decntaminatin prir t returning these facilities t nrmal use. Hwever, these actins will nt prvide prtectin f the patient r the attendants frm radiatin. Therefre, cntaminatin cntrl effrts shuld nt be carried ut if they wuld delay urgent medical care fr the patient. Likewise, cntaminatin n the patient shuld nt be f significant cncern with regard t expsure f the vehicle crew t radiatin; therefre, urgent medical care fr the victim shuld nt be delayed in rder t prvide special radiatin prtectin fr the vehicle crew. Extent f Play Medical persnnel shuld demnstrate all cntaminatin cntrl measures as they wuld in an actual emergency. The individual's injuries and degree f cntaminatin shuld be indicated n an attached tag r simulated by cntrller inject. L.4. 3. The apprpriate fficial makes a determinatin n the identity f the medical facility t which the individual will be taken and the individual is transprted withut undue delay. Explanatin D.20-4 September 1991
Respnsible OROs shuld demnstrate the capability t make determinatins n the identity f an apprpriate medical facility t which an individual is transprted. Persnnel respnsible fr determining the medical facility t which cntaminated, injured, r expsed individuals will be taken shuld knw the names and lcatins f medical facilities whse OROs have agreements fr care f such individuals. OROs shuld demnstrate the capability t decide t which medical facility individuals shuld be taken, giving cnsideratin t cntaminatin and injury prblems in the exercise. The vehicle crew shuld demnstrate the capability t drive the individual t the selected medical facility withut undue delay. Extent f Play Under this criterin, transprt f the simulated cntaminated, injured, r expsed individual t a medical facility shuld be perfrmed as it wuld be in an actual emergency. Hwever, the use f flashing lights and sirens are nt necessary during the exercise play. The capability t make decisins t freg radilgical mnitring and cntaminatin cntrl measures and t select the clsest medical facility fr a cntaminated, injured, individual with an urgent medical cnditin shuld be evaluated thrugh interviews. Transprt service(s) invlved in the exercise may be designated befre the exercise. If the service demnstrating medical transprt capabilities has bth nsite and ffsite respnsibilities, demnstratin f this bjective shuld be accmplished by transprt f either an ffsite r nsite individual. Nn-specialized vehicles (e.g., cars) may be used t transprt individuals instead f ambulances. If OROs decide t use ambulances, and they are needed fr respnse t actual emergencies, nn-specialized vehicles may be substituted t cmplete the transprtatin phase f the medical services demnstratin. L.4 4. Cmmunicatins are maintained with the receiving medical facility. Explanatin Vehicle crews shuld demnstrate the capability t maintain cmmunicatins with the receiving medical facility s that advance preparatins essential fr receipt f a cntaminated injured individual can be initiated (See Objective 21, Medical Services - Facilities). Vehicle crews shuld demnstrate the capability t cmmunicate with the medical facility infrmatin and data n the individual's physical cnditin, vital signs, radiatin mnitring results data, and estimated time f arrival. Extent f Play D.20-5 September 1991
Under this criterin, all activities shuld be cmpleted as they wuld be in an actual emergency. Data fr cmmunicatin by the crew shuld be prvided by cntrller injects. J.9., 5. The vehicle and its ccupants are mnitred t detect the L.1.,3. nature and extent f radilgical cntaminatin and decntaminated, if necessary. Explanatin The mnitring technician shuld demnstrate the capability t mnitr the vehicle crew and the vehicle and decide n the need fr decntaminatin after cntaminated, injured, r expsed individuals have been delivered t the receiving medical facility. Respnsible OROs shuld demnstrate prcedures t ensure that neither the vehicle nr any member f the vehicle crew is allwed t return t regular service withut cntaminatin evaluatin and decntaminatin, as necessary. OROs shuld demnstrate the use f a Geiger-Mueller type gamma survey instrument described under Demnstratin Criterin 1 fr mnitring the vehicle and the vehicle crew. The mnitring technician(s) shuld demnstrate the capability t use actin levels fr detecting radilgical cntaminatin and fr determining the need fr decntaminatin f vehicles. They shuld demnstrate the capability t determine the need t refer cntaminated vehicle crew members and a cntaminated vehicle(s) t the mnitring and decntaminatin center described in Objective 22, Emergency Wrkers, Equipment and Vehicles-Mnitring and Decntaminatin. Prir t using an instrument(s) fr mnitring, the mnitring technician shuld demnstrate the prcess f checking the instrument(s) fr prper peratin. This invlves checking the battery status, measuring the radiatin frm the accmpanying check-surce, and cmparing the result t the prper reading stated n the label. Once the perability f the survey instrument is cnfirmed, backgrund radiatin levels shuld be determined in the immediate vicinity where individuals will be mnitred. An instrument that des nt respnd prperly t these parameters shuld nt be used. Fr vehicles and equipment, the recmmendatins are nt less than 300 cpm using a CD V-700 survey instrument with the beta shield pen r equivalent. After decntaminatin, the recmmendatins are five mr/h n a CD V-700 fr fixed cntaminatin with the measurements being made with the beta shield clsed. (These levels are currently being reevaluated.) The mnitrs shuld demnstrate the use f prcedures that prvide fr the release f decntaminated vehicles fr cntinued use. D.20-6 September 1991
Extent f Play Under this criterin, all activities shuld be cmpleted as they wuld be in an actual emergency, except that it is nt necessary t demnstrate decntaminatin f the vehicle crew and the vehicle. Decisins n where t send a vehicle and crew fr decntaminatin may be evaluated by the interview prcess. N.1.a. 6. All activities described in the demnstratin criteria fr this bjective are carried ut in accrdance with the plan, unless deviatins are prvided fr in the extent-f-play agreement. Explanatin Respnsible OROs shuld demnstrate the capability t fllw plicies, implement prcedures, and utilize equipment and facilities cntained in their plans and prcedures. OROs shuld demnstrate that they can fllw sequences utlined in the varius prcedures and perfrm specified activities, as necessary. Extent f Play Under this criterin, all activities shuld be carried ut as specified in the plan, unless deviatin frm the plan is prvided fr in the extent-f-play agreement. CLARIFICATION OF TERMS The fllwing definitins describe the limited meaning f terms in the cntext f the Exercise Evaluatin Methdlgy and may vary frm the full technical definitin fr all circumstances. Actin levels refers t threshlds fr cntaminatin levels that trigger the need fr decntaminatin established in the plans. Cntaminated, injured, r expsed individuals refers t individuals wh are: cntaminated, cntaminated and therwise physically injured, r expsed t high levels f radiatin. Cntrller inject refers t the intrductin f events, data, and infrmatin int exercises t drive the demnstratin f bjectives. Emergency wrker refers t an individual wh has an essential missin within r utside the plume expsure pathway emergency planning zne t prtect the health and safety f D.20-7 September 1991
the public wh culd be expsed t inizing radiatin frm the plume r frm its depsitin. Sme examples f emergency wrkers are: radiatin mnitring persnnel; traffic cntrl persnnel; evacuatin vehicle drivers; fire and rescue persnnel, including ambulance crews; medical facilities persnnel; emergency peratins center persnnel; persnnel carrying ut backup alerting prcedures; and essential services r utility persnnel. Facility refers t any building, center, rm(s), r mbile unit(s) designed and equipped t supprt emergency peratins. Fixed cntaminatin refers t cntaminatin that remains after lse cntaminatin has been remved by simple decntaminatin. Geiger-Mueller detectr refers t a type f radiatin detectr that can be used t measure the gamma, r beta plus gamma radiatin depending n whether the detectr is cvered by a beta shield. Health physics technician refers t an individual trained in radiatin prtectin. Fr this bjective, such individuals advise medical facility staff regarding the radilgical mnitring and decntaminatin f individuals. High levels f radiatin expsure refers t dses f 100 rem r mre. Injured individual, as used in this bjective, refers t an individual with external injuries (e.g., brken leg), acute internal cnditins (e.g., heart attack), r sme cmbinatin theref. Measuring refers t cunting t detect radiatin levels r determining ther parameters, such as the energy f radiatin r physical characteristics f samples, such as the vlume f an air sample. Mnitring refers t the measurement f radiatin levels, usually with a prtable survey instrument. Recvery refers t the prcess f reducing radiatin expsure rates and cncentratins f radiactive material in the envirnment t acceptable levels fr return by the general public fr uncnditinal ccupancy r use after the emergency phase f a radilgical emergency. Urgent medical cnditin, as used in this bjective, refers t prblems fr which a delay in treatment may cause extended recvery time, reduced level f recvery, r death. D.20-8 September 1991