EMERGENCY OPERATIONS PLAN

Transcription

1 CHATHAM COUNTY HEALTH DEPARTMENT AND CHATHAM EMERGENCY MANAGEMENT AGENCY EMERGENCY OPERATIONS PLAN INCIDENT ANNEX G OCTOBER 2013

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3 Chatham County Radiological Response Plan Recommendations for Continued Additions/Modifications: Appendix A Include monitoring parameters for equipment to be used at Community Reception Centers (CRC): Thermo Scientific Rad Eye B20-ER (hand held; alpha, beta, gamma, x-ray) Rad Eye G (hand held; gamma) Rad Eye PRD-ER (hand held; gamma) Transportable Portal Monitor (TPM)-903B (portal; gamma) Appendix B In addition to monitoring parameters, establish surface contamination detection parameters based on guidelines in Appendix B, citing multiple agency/scenario recommendations. Create tables, based on type of nuclear event, to include the following information: Surface contamination level parameters (lowest, highest) as established by agency Using monitoring parameters from Appendix A, establish equipment specific readings/limits (using conversion factors, etc., if necessary) to incorporate into table format as an easy to read guide for workers at CRCs who will be performing population monitoring in real time. *Population monitoring instructions should be based solely on the equipment available for use* Appendix E Specialized training for designated personnel in manners of operational logistics at CRCs should be developed for, but not be limited to: Guidelines for the establishment of population registries Triage Management/treatment of special populations Population monitoring/decontamination protocols Opening, closing and decontamination of reception centers Public transportation agreements, route development, procedures Special provisions such as supplies, kits, food, water and clothing needed at CRCs Risk/hazard communication guidelines for the public Local agency contact information i OCTOBER 2013

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5 ACRONYMS AND DEFINITIONS ALI ARC ARS CBC CCHD CDC CEMA CERCLA CMHT CMRT CRC CRCPD DHS DOD DOE EH EOC EOP EPA EPR ESF FBI FDA FEMA FRMAC FRPCC GDPH HHS HSOC Annual Limit of Intake American Red Cross Acute Radiation Syndrome Complete Blood Count Chatham County Health Department Centers for Disease Control and Prevention Chatham Emergency Management Agency Comprehensive Environmental Response Compensation and Liability Act Consequence Management Home Team Consequence Management Response Team Community Reception Center Conference of Radiation Control Program Directors, Inc U.S. Department of Homeland Security U.S. Department of Defense U.S. Department of Energy Environmental Health Emergency Operations Center Emergency Operations Plan U.S. Environmental Protection Agency Emergency Preparedness and Response Emergency Support Functions Federal Bureau of Investigation Food and Drug Administration Federal Emergency Management Agency Federal Radiological Monitoring and Assessment Center Federal Radiological Preparedness Coordinating Committee Georgia Department of Public Health U.S. Department of Health and Human Services Homeland Security Operations Center iii OCTOBER 2013

6 IAEA ICRP IIMG IMAAC IND JFO JIC MH MHUMC MRC NASA NCP NCRP NDA NIMS NIRT NPP NRC NRCC NRF NRP NSA PH POD PPE RAC RAP RDD RERT TPM International Atomic Energy Agency International Commission on Radiological Protection Interagency Incident Management Group Interagency Modeling and Atmospheric Assessment Center Improvised Nuclear Device Joint Field Office Joint Information Center Mental Health Memorial Health University Medical Center Medical Reserve Corps National Aeronautics and Space Administration National Contingency Plan National Council on Radiation Protection and Measurement National Defense Area National Incident Management System Nuclear Incident Response Team Nuclear Power Plant U.S. Nuclear Regulatory Commission National Response Coordination Center National Response Framework National Response Plan National Security Area Public Health Point of Dispensing Personal Protective Equipment Regional Assistance Committee Radiological Assessment Program Radiological Dispersal Device Radiological Emergency Response Team Transportable Portal Monitor iv OCTOBER 2013

7 USACE USCG USDA U.S. Army Corps of Engineers United States Coast Guard U.S. Department of Agriculture Absorbed dose: The amount of energy deposited by ionizing radiation in a unit mass of tissue is called radiation absorbed dose. It is expressed in units of joule per kilogram (J/kg), which is given the special name gray (Gy). The conventional (or non-si unit) unit of absorbed dose is the rad. [ 00 rad equals Gy; or Gy equals 0.0 rad]. For more information, see CDC Primer on Radiation Measurement: Activity (radioactivity): The rate of decay of radioactive material expressed as the number of atoms breaking down per second measured in units called becquerels or curies. Acute Radiation Syndrome (ARS): A serious illness caused by receiving a large dose of radiation energy penetrating the body within a short time period (usually minutes). The first symptoms include nausea, vomiting, and diarrhea starting within minutes to days after the exposure and lasting for minutes to several days; these symptoms may come and go. Then the person usually looks and feels healthy for a short time, after which he or she will become sick again with loss of appetite, fatigue, fever, nausea, vomiting, diarrhea, and possibly even seizures and coma. This seriously ill stage may last from a few hours to several months. Clinically, ARS is very difficult to diagnose in the absence of any other radiological information from the incident scene because symptoms within the first few hours after exposure are no different from common diarrhea, vomiting, and nausea. Proper diagnosis of exposure to ionizing radiation (no contamination) and an estimate of the total dose can only be achieved by analysis of the complete blood count (CBC), chromosome aberration cytogenetic bioassay, and consultation with radiation experts. For more information, see CDC fact sheets: Acute Radiation Syndrome Acute Radiation Syndrome: A Fact Sheet for Physicians Alpha particle: One of the primary ionizing radiations, the others being beta particles, gamma-rays, x-rays, and neutrons. Alpha particles can be stopped by a thin layer of light material, such as a sheet of paper, and cannot penetrate the outer, dead layer of skin. Therefore, they do not pose a hazard as long as they are outside the body. Protection from this radiation is directed to preventing, or at least minimizing, inhalation or ingestion of the radioactive material. Alpha particles are difficult to detect in an accidental situation because they penetrate only a few inches in air, and most general purpose detection instruments are poorly suited to this particular detection scheme. If radiation is detected at an incident scene, instruments should be brought in as quickly as possible to determine whether alpha - emitting radioisotopes are present. v OCTOBER 2013

8 Annual Limit on Intake (ALI): The derived limit for the amount of radioactive material taken into the body of an adult worker by inhalation or ingestion in a year. ALI is the smaller value of intake of a given radionuclide in a year by the reference man resulting in a committed effective dose equivalent of 5 rem (0.05 sievert) or a committed dose equivalent of 50 rem (0.5 sievert) to any individual organ or tissue. The unit of ALI is the Becquerel (Bq) or the conventional unit, curie (Ci). Background radiation: Population is naturally and continually exposed to this type of radiation from natural sources. It consists of radiation from natural sources of radionuclides such as those found in soil, rocks, the air, our bodies, and our food, as well cosmic radiation originating in outer space. Becquerel (Bq): The SI unit describing the amount of radioactivity. One Bq is the amount of a radioactive material undergoing one decay (disintegration) per second, a very small rate. Industrial sources of radioactivity are normally described in terms of giga-bequerels (GBq), or one billion Bq. The conventional unit for radioactivity is the curie (Ci). [ Ci is equal to 3.7 x 0 0 Bq] Beta particles: One of the primary ionizing radiations, the others being alpha particles, gamma-rays, x-rays, and neutrons. They travel only a few feet in air and can be stopped by a thin sheet of aluminum. However, beta particles can penetrate the dead skin layer and, if present in large amounts or long period of time, cause skin burns. Protection from this radiation is directed toward washing the skin with mild soap and water and preventing, or at least minimizing, inhalation or ingestion of the radioactive material. Beta particles are easier to detect than alpha particles. While most general purpose detection instruments can detect beta particles, the instrument must be within a few yards of a sizeable source. Fortunately, the vast majority of beta-emitting radioisotopes release high-energy gamma rays and can be detected at distances of tens of yards. When radiation is detected at an incident scene, proper instruments should be brought in as quickly as possible to determine whether pure beta-emitting radioisotopes are present or not, followed in turn by alpha monitoring equipment. Bioassay (radiobioassay): An assessment of radioactive materials present inside a person s body through direct analysis of the radioactivity in a person s blood, urine, feces, or sweat, or by detection methods to monitor the radiation emitted from the body. Biological half-life: Once an amount of radioactive material has been taken into the body, this is the time it takes for one half of the amount to be expelled from the body by natural metabolic processes, not counting radioactive decay. Contamination (radioactive): The deposit of unwanted radioactive material on the surfaces of structures, areas, objects, or people (where it may be external or internal). External contamination occurs when radioactive material is outside of the body, such as on a person s skin. Internal contamination occurs when radioactive material is taken into the body through breathing, eating, or drinking. For more information, see CDC fact vi OCTOBER 2013

9 sheet: Radioactive Contamination and Radiation Exposure Curie (Ci): The conventional unit describing the amount of radioactivity. See Becquerel (Bq). Cutaneous Radiation Syndrome: The complex syndrome resulting from significant skin exposure to radiation. The immediate effects can be reddening and swelling of the exposed area (like a severe burn), blisters, and ulcers on the skin, hair loss, and severe pain. Very large doses can result in permanent hair loss, scarring, altered skin color, deterioration of the affected body part, and death of the affected tissue (requiring surgery). For more information, see CDC fact sheets: Acute Radiation Syndrome Radiation Injury: Fact Sheet for Physicians Decontamination: Removal of radioactive materials from people, materials, surfaces, food, or water. For people, external decontamination is done by removal of clothing and washing the hair and skin. Internal decontamination is a medical procedure. Decay, radioactive: Disintegration of the nucleus of an unstable atom by the release of radiation. Deterministic effects (non-stochastic effects): Health effects related directly to the radiation dose received (e.g., skin burn). The severity increases as the dose increases. A deterministic effect typically has a threshold below which the effect will not occur. See also stochastic effects. Dirty bomb: A device designed to spread radioactive material by conventional explosives when the bomb explodes. A dirty bomb kills or injures people through the initial blast of the conventional explosive and spreads radioactive contamination over a possibly large area hence the term dirty. Such bombs could be miniature devices or large truck bombs. A dirty bomb is much simpler to make than a true nuclear weapon. See discussion on RDD in the text. Dose rate meters: Instruments capable of measuring the radiation dose delivered per unit of time. Dose Reconstruction: A scientific study estimating doses to people from releases of radioactivity or other pollutants. The reconstruction is done by determining how much material was released, how people came in contact with it, and the amount absorbed by their bodies. Dosimetry: Assessment (by measurement or calculation) of radiation dose. vii OCTOBER 2013

10 Effective half-life: The time required for the amount of a radionuclide deposited in a living organism to be diminished by 50% as a result of the combined action of radioactive decay and biologic elimination. See also biological half-life, radioactive halflife. Exposure (irradiation): This occurs when radiation energy penetrates the body. Exposure to very large doses of radiation may cause death within a few days or months. Exposure to lower doses of radiation may lead to an increased risk of developing cancer or other adverse health effects later in life. Compare with contamination. For more information, see CDC factsheet: Radioactive Contamination and Radiation Exposure Fallout, nuclear: The slow descent of minute particles of radioactive debris in the atmosphere following a nuclear explosion. For more information, see Chapter of CDC s Fallout Report at: Gamma rays: One of the primary ionizing radiations, the others being alpha particles, beta particles, x-rays, and neutrons. Different from alpha and beta particles, gammarays are very similar to x-rays and pose an external radiation hazard. Gamma-rays are highly penetrating (up to tens of yards in air). Gamma rays also penetrate tissue farther than do beta or alpha particles. Gamma-rays are relatively easy to detect with common radiation detection equipment. Geiger counter: Geiger-Mueller or GM counters are the most widely recognized and commonly used portable radiation detection instruments. The modern pancake GM detector can detect gamma, beta, and to a limited extent, alpha contamination. The sensitivity of various GM probes varies markedly. For example, an old civil defense instrument and a modern instrument will record very different readings when used side by side. Knowledgeable and experienced radiation protection specialists should interpret the measurement results. Genetic effects: Hereditary effects (mutations) can be passed on through reproduction because of changes in sperm or ova. See also teratogenic effects, somatic effects. Gray (Gy): A unit of measurement for absorbed dose. It measures the amount of energy absorbed in a material. The unit Gy can be used for any type of radiation, but it does not describe the biological effects of the different radiations. For more information, see CDC Primer on Radiation Measurement: Half-life (radioactive): The time it takes for any amount of radioactive material to decay (and reduce) to half of its original amount. See also biological half-life, effective half-life, and radioactive half-life. viii OCTOBER 2013

11 Health physics: A scientific field focusing on protection of humans and the environment from radiation. Health physics uses physics, biology, chemistry, statistics, and electronic instrumentation to help protect people from any potential hazards of radiation. For more information, see the Health Physics Society Website: Health Physicist: A specialist in radiation safety. See health physics. Intake: Amount of radioactive material taken into the body by ingestion, inhalation, or absorption through the skin, via wounds or injection. Ionizing radiation: Any radiation capable of displacing electrons from atoms, thereby producing ions. High doses of ionizing radiation may produce severe skin or tissue damage Irradiation: Exposure to radiation. See exposure and compare with contamination. Latent period: The time between exposure to a toxic material and the appearance of a resultant health effect. Neutron: One of the primary ionizing radiations, the others being alpha particles, beta particles, gamma-rays, and x-rays. Neutrons are highly penetrating and are a radiation hazard at the instance of a nuclear detonation. It is unlikely for PH officials to encounter neutron radiation or contamination. Detection of neutrons requires specialized equipment. Non-stochastic effects: See deterministic effects. Penetrating radiation: Radiation penetrating the skin and reaching internal organs and tissues. Photons (gamma rays and x-rays), neutrons, and protons are penetrating radiations. However, alpha particles and all but extremely high-energy beta particles are not considered penetrating radiation. Portal Monitor: A portable doorway-like radiation detection system for monitoring people for radioactive contamination. The monitors look similar to metal detectors used in airport security screening stations. Certain types of portal monitors are used routinely to monitor vehicles or waste containers leaving hospitals. When used to monitor people, they can be used in walk-through mode or by having each person stand in the monitor for a brief time period. The portal monitors do NOT produce radiation. They can only measure radiation coming from contaminated individuals. Plume A cloud, gas, or vapor carring radioactive material released into the atmosphere away from the incident site in the direction of the wind. Making plume concentration predictions with time after the incident is necessary to determine whether affected ix OCTOBER 2013

12 populations should shelter in place or evacuate. Plume predictions use mathematical models and, although very helpful, are prone to inherent uncertainties. Prenatal radiation exposure: Radiation exposure to an embryo or fetus while it is still in its mother s womb. At certain stages of the pregnancy, the fetus is particularly sensitive to radiation, and the health consequences could be severe above certain radiation dose levels. For more information see CDC fact sheets: Possible Health Effects of Radiation Exposure on Unborn Babies Prenatal Radiation Exposure: A Fact Sheet for Physicians Rad (radiation absorbed dose): See absorbed dose. For more information, see CDC Primer on Radiation Measurement: Radiation: Energy moving in the form of particles or waves. Familiar radiations are heat, light, radio waves, and microwaves. Ionizing radiation is a very high-energy form of electromagnetic radiation. Radiation sickness: See acute radiation syndrome (ARS). Radioactive contamination: See contamination. Radioactive decay: The spontaneous disintegration of the nucleus of an atom. Radioactive half-life: See half-life. Radioactive material: radiation as they decay. Material containing unstable (radioactive) atoms giving off Radioactivity: The process of spontaneous transformation of the nucleus, generally with the emission of alpha or beta particles and are often accompanied by gamma rays. This process is referred to as decay or disintegration of an atom. See activity. Radiobioassay: See bioassay. Radiogenic: Health effects caused by exposure to ionizing radiation. Radiological or radiologic: Related to radioactive materials or radiation. The radiological sciences focus on the measurement and effects of radiation. Radionuclide: An unstable and therefore radioactive form of a nuclide. Rem (roentgen equivalent, man): A conventional unit for a derived quantity called radiation dose equivalent. One rem equals 0.0 Sieverts (Sv). See Sievert. x OCTOBER 2013

13 Resuspension: The physical process of making airborne radioactive contamination which otherwise would have remained deposited on the surface of objects. For example, wind blowing across a sidewalk will resuspend previously deposited contaminants, making them airborne in the breathing zone. Roentgen (R): A unit of exposure to x-rays or gamma rays. Shielding: The material between a radiation source and a potentially exposed person reducing his or her exposure. Sievert (Sv): The SI unit for a derived quantity called radiation dose equivalent. This relates the absorbed dose in human tissue to the effective biological damage of the radiation. Radiation does not always have the same biological effect, even for the same amount of absorbed dose. Dose equivalent is often expressed as millionths of a sievert, or micro-sieverts (µsv). One sievert is equivalent to 00 rem. For more information, see CDC Primer on Radiation Measurement: S.I. units: The Systeme Internationale (or International System) of units and measurements. This system of units has been adopted by most countries, although the amount of actual usage varies considerably. For more information, see CDC Primer on Radiation Measurement: Somatic effects: Effects of radiation limited to the exposed person, as distinguished from genetic effects, which may also affect subsequent generations. See also teratogenic effects. Stochastic effects: Health effects occuring on a random basis independent of the size of dose (e.g., cancer). The effect typically has no threshold and is based on probabilities, with the chances of seeing the effect increasing with dose. If it occurs, the severity of a stochastic effect is independent of the dose received. See also deterministic effect. Teratogenic effect: Birth defects not passed on to future generations, caused by exposure of a fetus to a toxin. See also genetic effects, somatic effects. xi OCTOBER 2013

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15 TABLE OF CONTENTS Revisions... i Acronyms and Definitions... iii Table of Contents... xiii I. Introduction... 1 II. Purpose... 1 III. Scope... 2 IV. Policies... 3 V. Planning Assumptions... 7 VI. Roles and Responsibilities... 9 A. Chatham County Health Department... 9 B. Epidemiology C. Risk Communication D. Environmental Health E. Public Health Nursing F. Mental Health G. Chatham Emergency Management Agency H. Assisting Agencies I. American Red Cross Responsibilities J. US Department of Agriculture K. Department of Commerce L. Department of Defense VIII. Concept of Operations A. General B. Hazard Specific Planning and Preparedness C. Incident Actions D. Recovery E. Federal Assets Available Upon Request F. Advisory Team G. DOE Radiological Assistance Program xiii OCTOBER 2013

16 APPENDICES Appendix 1 CRC Specifications Appendix 2 Radiological Screening Criteria External Contamination Appendix 3 Radiological Screen Criteria Internal Contamination Appendix 4 Triage Tags Appendix 5 Operational Procedures for a Radiological Event Appendix 6 CRC Action Sheets Appendix 7 Radiological Countermeasures Distribution form xiv OCTOBER 2013

17 I. INTRODUCTION A. To date, the United States has no experience with responding to a largescale nuclear or radiological terrorism incident on domestic soil. However, government authorities and other experts believe a terrorist attack involving the use of a radiological or nuclear device is imminent. B. Therefore, the Chatham County Emergency Operations Plan (EOP) will address the potential threat of a radiological or nuclear terrorism event where crisis management personnel are likely to be overwhelmed quickly with mass casualties, and population monitoring will be used to assess and mitigate adverse health outcomes. II. PURPOSE A. The Nuclear/Radiological Incident Annex provides an integrated and coordinated response to terrorist incidents involving nuclear or radioactive materials (Incidents of Critical Significance), and accidents or incidents involving such material may or may not rise to the level of an Incident of National Significance. The Chatham County Health Department (CCHD) and Chatham Emergency Management Agency (CEMA) are responsible for overall coordination of actual and potential Incidents of Critical Significance, including terrorist incidents involving nuclear materials. B. This annex describes integrated primary and support agency function in response to a nuclear/ radiological Incident of Critical Significance. In addition, this annex describes how the primary agencies lead the response to incidents of lesser severity. C. The actions described in this annex may be implemented: (1) concurrently with, and as an integral part of, the EOP for nuclear/radiological incidents or accidents considered to be Incidents of Critical Significance; or (2) independently for nuclear/ radiological accidents or incidents considered to be below the threshold of an Incident of Critical Significance and, therefore, not requiring overall Federal coordination by the U.S. Department of Homeland Security (DHS). D. The purpose of this plan is to outline the core responsibilities of CCHD in response to a radiological mass casualty event. Chatham County is estimated to have a population of approximately 136,000 according to the latest 2010 census. Population monitoring is an essential component of emergency response planning for radiation emergencies and will be a core function of CCHD in the wake of such an event. CCHD and support agency personnel and operations functions shall be mobilized in the first few hours after the incident, before the arrival of state or federal assets. 1 OCTOBER 2013

18 Therefore, it is critical for response efforts to consider population size when determining operations logistics, as well as key personnel and other resource allocation. III. SCOPE A. This annex applies to nuclear/radiological incidents, including sabotage and terrorist incidents, involving the release or potential release of radioactive material. This includes terrorist use of (RDDs) or improvised nuclear devices (INDs) as well as reactor plant accidents (commercial or weapons production facilities), lost radioactive material sources, transportation accidents involving nuclear/ radioactive material, and foreign accidents involving nuclear or radioactive material. B. The level of response to a specific incident is based on numerous factors, including the ability of local officials to respond; the type and/or amount of radioactive material involved; the extent of the impact or potential impact on the public and environment; and the size of the affected area. C. Actions are coordinated in accordance with pre-incident prevention protocols set forth in the EOP Base Plan anytime a possibility of a terrorist incident involving Radiological materials exists. D. This annex: 1. Provides planning guidance and outlines operational concepts for the response to any nuclear/radiological incident, including a terrorist incident, in which there is actual, potential, or perceived radiological consequences within the Chatham County or its adjacent waters, and requires Government response. This includes both Incidents of Critical Significance and incidents of lesser severity; 2. Acknowledges the unique nature of a variety of nuclear/radiological incidents and the responsibilities of various levels of government to respond to them; 3. Describes policies and planning considerations on which this annex and agency-specific nuclear/radiological response plans are based; 4. Specifies the roles and responsibilities of Governmental agencies for preventing, preparing for, responding to, and recovering from nuclear/radiological incidents; 5. Includes guidelines for notification, coordination, and leadership of activities, and coordination of public information; and 2 OCTOBER 2013

19 6. Provides protocols for coordinating Government capabilities to respond to radiological incidents. These capabilities include, but are not limited to: a. The Interagency Modeling and Atmospheric Assessment Center (IMAAC), which is responsible for production, coordination, and dissemination of consequence predictions for an airborne hazardous material release; b. The Federal Radiological Monitoring and Assessment Center (FRMAC), established at or near the scene of an incident to coordinate radiological assessment and monitoring; and c. The Advisory Team for Environment, Food, and Health (known as the Advisory Team ), which provides expert recommendations on protective action guidance. IV. POLICIES A. Because of the unique capabilities of the Federal government to respond to acts of terrorist incidents involving nuclear or radioactive materials, it retains responsibility over such incidents. Specifically, DHS coordinates the overall Federal Government response to radiological incidents In accordance with Homeland Security Presidential Directive 5, the Secretary of Homeland Security is the principal Federal official for domestic incident management. The Secretary is responsible for coordinating Federal operations within the United States to prepare for, respond to, and recover from terrorist attacks, major disasters, and other emergencies. The Secretary shall coordinate the Federal Government s resources utilized in response to or recovery from terrorist attacks, major disasters, or other emergencies. B. The National Response Framework (NRF), like its predecessor, the National Response Plan (NRP), supersedes the Federal Radiological Emergency Response Plan dated May 1, C. The concept of operations described in this annex recognizes and addresses the unique challenges associated with and the need for specialized technical expertise/actions when responding to RDD/IND incidents with potentially catastrophic consequences. 3 OCTOBER 2013

20 D. The Federal Government has established protective action guidance for radiological incidents. Specific protective action guidance has also been established for RDD/INDs. E. DHS, as the overall incident manager for Incidents of National Significance, is supported by primary agencies and support agencies. Primary agencies have specific nuclear/radiological technical expertise and assets for responding to the unique characteristics of these types of incidents. Primary agencies facilitate the nuclear/radiological aspects of the response in support of DHS. For any given incident, the primary agency is the Federal agency owning, having custody of, authorizing, regulating, or otherwise designated responsible for the nuclear/radioactive material, facility, or activity involved in the incident. The primary agency is represented in the Joint Field Office (JFO) Coordination Group, the Interagency Incident Management Group (IIMG), and the Homeland Security Operations Center (HSOC). The primary agency is also represented in other response centers and entities, as appropriate for the specific incident. F. Primary agencies are also responsible for leading the Federal response to nuclear/ radiological incidents of lesser severity. G. Primary agencies may use the structure of the NRF to carry out their response duties, or any other structure consistent with the National Incident Management System (NIMS) capable of providing the required support to the affected State or local governments. H. When DHS initiates the response mechanisms of the NRF, including the Emergency Support Functions (ESFs), appropriate NRF Support Annexes, and the Nuclear/Radiological Incident Annex, existing interagency plans address nuclear/radiological incident management (e.g., the National Oil and Hazardous Substances Pollution Contingency Plan) are incorporated as supporting plans and/or operational supplements to the NRF. I. Support agencies include other Federal agencies providing technical and resource support to DHS and primary agencies. These agencies are represented in the IIMG, the HSOC, and other response centers and entities, as appropriate for the specific incident. They may or may not be represented in the JFO Coordination Group. J. The Attorney General, generally acting through the Federal Bureau of Investigation (FBI), has lead responsibility for criminal investigations of terrorist acts or terrorist threats and for coordinating activities of other members of the law enforcement community to detect, prevent, preempt, 4 OCTOBER 2013

21 Investigate, and disrupt terrorist attacks against the United States, including incidents involving nuclear/radioactive materials, in accordance with the following: 1. The Atomic Energy Act directs the FBI to investigate alleged or suspected criminal violations of the act. Additionally, the FBI legally is responsible for locating any illegally diverted nuclear weapon, device, or material and for restoring nuclear facilities to their rightful custodians. In view of its unique responsibilities under the Atomic Energy Act (amended by the Energy Reorganization Act), the FBI has concluded formal agreements with the primary agencies providing for interface, coordination, and technical support for the FBI s law enforcement and criminal investigative efforts. 2. Generally, for nuclear facilities and materials in transit, the designated primary agency and support agencies perform the functions delineated in this annex and provide technical support and assistance to the FBI in the performance of its law enforcement and criminal investigative mission. Those agencies supporting the FBI additionally coordinate and manage the technical portion of the response and activate/request assistance under this annex for measures to protect the public health (PH) and safety. The FBI manages and directs the law enforcement and intelligence aspects of the response, while coordinating its activities with appropriate Federal, State, and local governments within the framework of this annex, and/or as provided for in established interagency agreements or plans. Further details regarding the FBI response are outlined in the Terrorism Incident Law Enforcement and Investigation Annex. 3. Federal nuclear/radiological assistance capabilities outlined in this annex are available to support the Federal response to a terrorist threat, whether or not the threat develops into an actual incident K. When the concept of operations in this annex is implemented, existing interagency plans address nuclear/radiological incident management are incorporated as supporting plans and/or operational supplements (e.g., the National Oil and Hazardous Substances Pollution Contingency Plan. L. This annex does not create any new authorities nor change any existing ones. M. Nothing in this annex alters or impedes the ability of Federal departments and agencies to carry out their specific authorities and perform their responsibilities under law. 5 OCTOBER 2013

22 N. Some Federal agencies are authorized to respond directly to certain incidents affecting PH and safety. In these cases, procedures outlined in this annex may be used to coordinate the delivery of Federal resources to State and local governments and to coordinate assistance among Federal agencies for incidents and can be managed without the need for DHS coordination (i.e., incidents below the threshold of an Incident of National Significance). O. The owner/operator of a nuclear/radiological facility primarily is responsible for mitigating the consequences of an incident, providing notification and appropriate protective action recommendations to State and local government officials, and minimizing the radiological hazard to the public. The owner/operator has primary responsibility for actions within the facility boundary and may also have responsibilities for response and recovery activities outside the facility boundary under applicable legal obligations (e.g., contractual; licensee; Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA)). P. State and local governments primarily are responsible for determining and implementing measures to protect life, property, and the environment in those areas outside the facility boundary or incident location. This does not, however, relieve nuclear/radiological facility or material owners/operators from any applicable legal obligations. Q. State and local governments and owners/operators of nuclear/radiological facilities or activities may request assistance directly from DHS, other Federal agencies, and/or State governments with which they have preexisting arrangements or relationships. R. Response to nuclear/radiological incidents affecting land owned by the Federal Government is coordinated with the agency responsible for managing land and to ensure incident management activities are consistent with Federal statutes governing use and occupancy. S. Participating Federal agencies may take appropriate independent emergency actions within the limits of their own statutory authority to protect the public, mitigate immediate hazards, and gather information concerning the emergency to avoid delay. T. Federal coordination centers and agency teams provide their own logistical support consistent with agreed upon interagency execution plans. Local governments are encouraged to coordinate their efforts with the 6 OCTOBER 2013

23 U. State and Federal effort, but maintain their own logistical support, consistent with applicable authorities and requirements. V. For radiological incidents involving a nuclear weapon, special nuclear material, and/or classified components, the agency with custody of the material (the U.S. Department of Defense (DOD), the U.S. Department of Energy (DOE), or the National Aeronautics and Space Administration (NASA)) may establish a National Defense Area (NDA) or National Security Area (NSA). NDAs and NSAs are established to safeguard classified information and/or restricted data, or equipment and material, and place non-federal lands under Federal control for the duration of the incident. In the event radioactive contamination occurs, Federal officials coordinate with State and local officials to ensure appropriate PH and safety actions are taken outside the NDA or NSA. V. PLANNING ASSUMPTIONS A. Radiological incidents may not be immediately recognized as such until the radioactive material is detected or the health effects of radiation exposure are manifested in the population and identified by the PH community. B. An act of nuclear or radiological terrorism can have major consequences and can overwhelm the capabilities of many local, tribal, and/or State governments to respond, and may seriously challenge existing Federal response capabilities. C. A radiological incident may require concurrent implementation of the National Contingency Plan (NCP) to address radiological, as well as chemical or biological, releases into the environment. D. An incident involving the potential release of radioactivity may require implementation of protective measures. E. An expeditious Federal response is required to mitigate the consequences of the nuclear/radiological incident. Radiological Incidents of National Significance resulting in significant impacts likely will trigger implementation of the NRF Catastrophic Incident Supplement and Annex. 7 OCTOBER 2013

24 F. The Federal Government response to radiological terrorist threats/incidents also includes the following assumptions: 1. If appropriate personal protective equipment and capabilities are not available and the area is contaminated by radioactive material, response actions in a contaminated area may be delayed until the material has dissipated to a safe level for emergency response personnel or until appropriate personal protective equipment and capabilities arrive, whichever is sooner; 2. The response to a radiological threat or actual incident requires an integrated Federal response, and will trigger concurrent activation of the Terrorism Law Enforcement and Investigation Annex. 3. In the case of a nuclear terrorist attack, the plume may be dispersed over a large area over time, requiring response operations to be conducted over a multijurisdictional and/or multistate region. 4. A terrorist attack may involve multiple incidents, and each location may require an incident response and a crime scene investigation simultaneously. 5. A State of Emergency has, or will, be declared 6. County, District, and State PH personnel will be available for response 7. Adequate numbers of qualified staff or volunteers will be available to support Reception Center operations 8. Non-essential PH services will be halted and resources redirected for response to the incident, if required 9. PH information and resources will be coordinated between district, Georgia Department of Public Health (GDPH) and Georgia Department of Human Resources Public Information Officers and the Joint Information Center (JIC) of CEMA 10. Communications systems will be in place and operational 11. Resources, including funding for response to the incident, will be identified, coordinated, and documented. Requests for reimbursement will be initiated through appropriate channels 8 OCTOBER 2013

25 12. Primary and alternate PH infrastructure resources have been identified secured and will be operational. VI. ROLES AND RESPONSIBILITIES A. CCHD 1. Will coordinate with the Coastal Health District in the allocation of PH resources and personnel to meet the needs of affected populations, as follows: 2. To coordinate ESF - 08 Health and Medical Response through the PH command structure and the CEMA Emergency Operations Center (EOC) and: a. Open Community Reception Center (CRC) as indicated b. Begin population monitoring efforts c. Ensure the medical needs of the community are met d. Assist local hospitals as requested. e. Identify critical PH resources and infrastructure in the affected area f. Provide accurate and timely guidance regarding the medical management exposed and contaminated victims g. To mobilize Medical Reserve Corps (MRC) volunteers and resources. h. To identify qualified volunteers through ServGA, including radiation control specialist to assist with survey and decontamination efforts i. To coordinate dispensing of necessary countermeasures available through the Strategic National Stockpile j. To organize strike teams to supplement PH CRC operations and population monitoring efforts k. To collaborate with the Georgia Division of PH and other partners to ensure the PH needs of the affected populations are met to the greatest extent possible. 9 OCTOBER 2013

26 B. Epidemiology: Will register individuals at reception centers or through callin lines: 1. Take exposure history (location, duration in plume, etc) and assess symptoms 2. Compile radiological survey and bioassay results 3. Perform long-term monitoring and surveillance. C. Risk Communication: Will work with GDPH, Department of Natural Resources, PH, and Georgia Emergency Management Agency subject matter experts in the JIC to provide information to the public regarding: 1. health risks of radiation exposure and contamination 2. protective action recommendations 3. performance of self decontamination 4. the location of the CRC D. Environmental Health (EH): In addition to EH s normal role in shelter operations, EH specialists may be called upon to: 1. distribute educational information among victims 2. assist with radiological surveys of contaminated individuals E. PH Nursing: In addition PH Nursing s normal role in sheltering operations, PH Nursing may be called upon to: 1. triage patients reporting to the CRC 2. dispense/administer medical countermeasures 3. assist epidemiology with patient tracking and monitoring efforts F. Mental Health (MH): In addition to MH s normal role in sheltering operations, grief counselors and crisis counselors may be called upon to: 1. answer questions from worried individuals regarding radiation exposure and contamination 2. evaluate and triage individuals according to counseling needs 10 OCTOBER 2013

27 3. provide individuals with information regarding the pursuit or necessity of long-term counseling care 4. coordinate with CRC managers and security personnel to remove disruptive or dangerous individuals from the crowd. G. CEMA: Act as the lead point of contact in any emergency situation. 1. Develop an EOC facility, a protected site from which key local officials control operations. 2. Coordinate and lead emergency communications planning, secure required equipment, and exercise emergency communications. 3. Establish and maintain a shelter system. 4. Establish and maintain an emergency public information system and train personnel to utilize it. 5. Coordinate with volunteer groups to develop an emergency welfare capability to care for people needing mass care as a result of any emergency. 6. Assist local operating departments such as the police department, fire department, and public works. 7. Ensure communications across agencies and jurisdictions 8. Alert the public and officials through Emergency Alert System H. Assisting Agencies: The American Red Cross (ARC) may be asked to coordinate shelter operations for displaced persons, however, only uncontaminated or decontaminated individuals may report to these shelters. 1. ARC will need to coordinate with established CRCs to ensure individuals reporting to the clean shelter have gone through the appropriate survey and decontamination. 2. Region J Coordinating Hospital: Memorial Health University Medical Center (MHUMC), In addition to normal emergency assistance activities, MHUMC may be asked to: a. Provide additional assistance for survey and decontamination efforts 11 OCTOBER 2013

28 b. Assess the available laboratory capacity among regional hospital I. ARC (See the ESF - 06 Mass Care, Housing, and Human Services Annex for additional information.) Assesses the mass care consequences of a radiological incident, and in conjunction with State, and local (including private-sector) mass care organizations, develop and implement a sustainable short-term and long-term strategy for effectively addressing the consequences of the incident. J. US Department of Agriculture (USDA): (See the ESF - 11 Agriculture and Natural Resources Annex for additional information.) 1. Inspects meat and meat products, poultry and poultry products, and egg products identified for interstate and foreign commerce to ensuring they are safe for human consumption. 2. Assists, in conjunction with the U.S. Department of Health and Human Services (HHS), in monitoring the production, processing, storage, and distribution of food through the wholesale level to eliminate contaminated product or to reduce the contamination in the product to a safe level. 3. Collects agricultural samples within the Ingestion Exposure Pathway Emergency Planning Zone (through the FRMAC). Assists in the evaluation and assessment of data to determine the impact of the incident on agriculture. 4. Assesses damage to crops, soil, livestock, poultry, and processing facilities and incorporates findings in a damage assessment report. 5. Provides emergency communications assistance to the agricultural community through the State Research, Education, and Extension Services electronic mail, or USDA telecommunications systems. 6. Supports/advises on decontamination and screening of pets and farm animals. 7. Assists in animal carcass disposal. K. Department of Commerce 1. Provides operational weather observations and prepares forecasts tailored to support emergency incident management activities. 12 OCTOBER 2013

29 2. Provides plume dispersion assessment and forecasts to the IMAAC and/or primary agency, in accordance with established procedures. 3. Archives, as a special collection, the meteorological data from national observing and numerical weather analysis and prediction systems applicable to the monitoring and assessment of the response. 4. Ensures marine fishery products available to the public are not contaminated. 5. Provides assistance and reference material for calibrating radiological instruments. 6. Provides radiation shielding materials. 7. In the event of materials potentially crossing international boundaries, serves as the agent for informing international hydrometeorological services and associated agencies through the mechanisms afforded by the World Meteorological Organization. 8. Provides radioanalytical measurement support and instrumentation. L. Department of Defense: Serves as a primary agency VII. CONCEPT OF OPERATIONS A. General 1. The most critical step Emergency Preparedness and Response (EPR) officials can take in preparing for a radiological event is to identify and collaborate with Local and State partners to develop a cohesive response plan. The resources and manpower necessary to effectively mount a radiological response far exceeds the capabilities of any single agency, therefore, interagency collaboration is essential to identify the realistic response roles of a particular organization. Furthermore, population monitoring is a PH mission requiring the support of many partner agencies. Establishing effective working relationships with these partner agencies early in the planning process will help bridge gaps existing in the response structure. 2. The CRC is central to radiological response planning and operations logistics for respective agencies, as well as the public. CCHD and the CEMA will be responsible for designating one or more locations to serve as CRCs and to establish the 13 OCTOBER 2013

30 corresponding Memorandum of Agreement/Memorandum of Understanding as necessary for each. A list of prospective locations for CRCs, as well as the recommended specifications for each can be found in Appendix A. 3. This concept of operations is applicable to potential and actual radiological Incidents of Critical Significance requiring DHS coordination and other radiological incidents of lesser severity, utilizing the protocols delineated in this annex. For other radiological incidents of lesser severity, other Federal response plans (i.e., the NCP and/or agency specific radiological incident. B. Hazard-Specific Planning and Preparedness 1. Headquarters a. The Federal Radiological Preparedness Coordinating Committee (FRPCC) provides a national-level forum for the development and coordination of radiological prevention and preparedness policies and procedures. It also provides policy guidance for Federal radiological incident management activities in support of State, local and tribal government radiological emergency planning and preparedness activities. The FRPCC is an interagency body consisting of the coordinating and support agencies discussed in this annex, chaired by DHS/EPR/Federal Emergency Management Agency (FEMA). The FRPCC establishes subcommittees, as necessary. b. The FRPCC also coordinates research-study efforts of its member agencies related to State, local and tribal government radiological emergency preparedness to ensure minimum duplication and maximum benefits to State and local governments. The FRPCC coordinates planning and validating requirements of each agency, reviewing integration requirements and incorporating agency-specific plans, procedures, and equipment into the response system. 2. Regional: Regional Assistance Committees (RACs) in the DHS/EPR/FEMA regions serve as the primary coordinating structure at the Federal regional level. RAC membership mirrors the membership of the FRPCC, and RACs and are chaired by a DHS/EPR/FEMA regional representative. Additionally, State emergency management agencies send representatives to RAC meetings and participate in regional exercise and training activities. The RACs provide a forum for information-sharing, consultation, 14 OCTOBER 2013

31 and coordination of Federal regional awareness, prevention, preparedness, response, and recovery activities. The RACs also assist in providing technical assistance to State and local governments and evaluating radiological plans and exercises. 3. Primary and Support Agencies: a. During a response to an incident, primary agencies and support agencies provide technical expertise, specialized equipment, and personnel in support of DHS, which is responsible for overall coordination of incident management activities. Primary agencies have primary responsibilities for Federal activities related to the nuclear/radiological aspects of the incident. The primary agency is the Federal agency which owns, has custody of, authorizes, regulates, or is otherwise deemed responsible for the radiological facility or activity involved in the incident. The following paragraphs identify the primary agency for a variety of radiological incidents. b. For example, the Nuclear Regulatory Commission (NRC) is the primary agency for incidents involving nuclear facilities licensed by the NRC; DOE is the primary agency for incidents involving the transportation of radioactive materials shipped by or for DOE. Table 1 identifies the primary agency for a variety of radiological incidents. 4. Radiological Terrorism Incidents: a. The primary agency provides technical support to DHS, which has overall responsibility for domestic incident management, and to the FBI, which has the lead responsibility for criminal investigations of terrorist acts or terrorist threats. The FBI also is responsible for coordinating activities of other members of the law enforcement community to detect, prevent, preempt, investigate, and disrupt terrorist attacks against the United States, including incidents involving nuclear/radioactive materials (e.g. RDD/IND incidents). b. Note: DHS is responsible for the overall coordination of incident management activities for nuclear or radiological Incidents of Critical Significance, including those involving terrorism. 15 OCTOBER 2013

32 5. Type of Incident Primary Agency a. Radiological terrorism incidents (e.g., RDD/IND or radiological exposure device): 1) Material or facilities owned or operated by DOD or DOE 2) Material or facilities licensed by NRC or Agreement State 3) Others a) DOD or DOE b) NRC c) DOE b. Nuclear facilities: 1) Owned or operated by DOD or DOE 2) Licensed by NRC or Agreement State 3) Not licensed, owned, or operated by a Federal agency or an Agreement State, or currently or formerly licensed facilities for which the owner/operator is not financially viable or is otherwise unable to respond a) DOD or DOE b) NRC c) U.S. Environmental Protection Agency (EPA) c. Transportation of radioactive materials: 1) Materials shipped by or for DOD or DOE 2) Shipment of NRC or Agreement State-licensed materials 3) Shipment of materials in certain areas of the coastal zone are not licensed or owned by a Federal agency or Agreement State (see United States Coast Guard 16 OCTOBER 2013

33 (USCG) list of responsibilities for further explanation of certain areas ) 4) Others a) DOD or DOE b) NRC c) DHS/USCG d) EPA d. Space vehicles containing radioactive materials: 1) Managed by NASA or DOD 2) Not managed by DOD or NASA impacting certain areas of the coastal zone 3) Others c) EPA a) NASA or DOD b) DHS/USCG e. Foreign, unknown or unlicensed material: 1) Incidents involving foreign or unknown sources of radioactive material in certain areas of the coastal zone 2) Others a) DHS/USCG b) EPA f. Nuclear weapon accident/incident (based on custody at time of event) DOD or DOE. Other types of incidents not otherwise addressed above DHS designates 1) For radiological terrorism incidents involving materials or facilities owned or operated by DOD or DOE, DOD or DOE is the primary agency, as appropriate. 17 OCTOBER 2013

34 6. Nuclear Facilities: 2) For radiological terrorism incidents involving materials or facilities licensed by the NRC or Agreement States, the NRC is the primary agency. 3) For other radiological terrorist incidents, DOE is the primary agency. The primary agency role transitions from DOE to the EPA for environmental cleanup and site restoration at a mutually agreeable time, and after consultation with State, and local governments, the support agencies, and the JFO Coordination Group. a. The NRC is the primary agency for incidents occurring at fixed facilities or activities licensed by the NRC or an Agreement State. These include, but are not limited to, commercial nuclear power plants (NPP), fuel cycle facilities, DOE-owned gaseous diffusion facilities operating under NRC regulatory oversight, independent spent fuel storage installations, radiopharmaceutical manufacturers, and research reactors. b. DOD or DOE is the primary agency for incidents occurring at facilities or vessels under their jurisdiction, custody, or control. These incidents may involve reactor operations, nuclear material, weapons production, radioactive material from nuclear weapons or munitions, or other radiological activities. c. EPA is the primary agency for incidents occurring at facilities not licensed, owned, or operated by a Federal agency or an Agreement State, or currently or formerly licensed facilities for which the owner/operator is not financially viable or is otherwise unable to respond. 7. Transportation of Radioactive Materials: a. Either DOD or DOE is the primary agency for transportation incidents involving DOD or DOE materials, depending on which of these agencies has custody of the material at the time of the incident. b. The NRC is the primary agency for transportation incidents involving radiological material licensed by the NRC or an Agreement State. 18 OCTOBER 2013

35 c. DHS/ USCG is the primary agency for the shipment of materials in certain areas of the coastal zone and are not licensed or owned by a Federal agency or Agreement State. d. EPA is the primary agency for shipment of materials in other areas of the coastal zone and in the inland zone and are not licensed or owned by a Federal agency or an Agreement State. 8. Space Vehicles Containing Radioactive Materials: a. NASA is the primary agency for missions involving NASA space vehicles or joint space vehicles with significant NASA involvement. DOD is the primary agency for missions involving DOD space vehicles or joint space vehicles with significant DOD involvement. A joint venture is an activity in which the U.S. Government has provided extensive design/financial input; has provided and maintains ownership of instruments, spacecraft, or the launch vehicle; or is intimately involved in mission operations. A joint venture is not created by simply selling or supplying material to a foreign country for use in its spacecraft. b. DHS/USCG is the primary agency for space vehicles not managed by DOD or NASA impacting certain areas of the coastal zone. c. EPA is the primary agency for other space vehicle incidents involving radioactive material. 9. Foreign, Unknown, or Unlicensed Material: EPA or DHS/USCG is the primary agency depending on the location of the incident. DHS/USCG is the primary agency for incidents involving foreign or unknown sources of radioactive material in certain areas of the coastal zone. EPA is the primary agency for other incidents involving foreign, unknown, or unlicensed radiological sources having actual, potential, or perceived radiological consequences in the United States or its territories, possessions, or territorial waters. The foreign or unlicensed source may be a reactor, a spacecraft containing radioactive material, imported radioactively contaminated material, or a shipment of foreign-owned radioactive material. Unknown sources of radioactive material, also termed orphan sources, are those materials whose origin and/or radiological nature are not yet established. These types of sources include contaminated scrap metal or abandoned radioactive 19 OCTOBER 2013

36 material. 10. Other Types of Incidents: For other types of incidents not covered above, DHS, in consultation with the other primary agencies, designates a primary agency. If DHS has determined it to be an Incident of Critical Significance, DHS is responsible for overall coordination and the designated primary agency assumes responsibilities as the primary agency. 11. Notification Procedures C. Incident Actions a. The owner/operator of a nuclear/radiological facility or owner/transporter of nuclear/radiological material is generally the first to become aware of an incident and notifies State, local and tribal authorities and the primary agency. b. Federal, State, and local governments aware of a radiological incident from any source other than the primary agency notify the HSOC and the primary agency. c. The primary agency provides notification of a radiological incident to the HSOC and other primary agencies, as appropriate. d. Releases of hazardous materials are regulated under the NCP (40 Code of Federal Regulation part 302) are reported to the National Response Center. 1. Headquarters: Incidents of Critical Significance a. Primary agencies and support agencies report information and intelligence relative to situational awareness and incident management to the HSOC. Agencies with radiological response functions provide representatives to the HSOC, as requested. b. The primary agency and support agencies, as appropriate, provide representation to the IIMG. c. Primary agencies and support agencies provide representation to the National Response Coordination Center (NRCC), as appropriate. 20 OCTOBER 2013

37 2. Other Radiological Incidents a. For radiological incidents below the threshold of an Incident of Critical Significance but require Federal participation in the response, the primary agency coordinates the Federal response utilizing the procedures in this annex, agencyspecific plans, and/or the NCP, as appropriate. The primary agency provides intelligence and information relative to the incident to the HSOC. b. The NRCC may be utilized to provide interagency coordination and Federal resource tracking, if needed. 3. Regional: Incidents of Critical Significance a. The primary agency provides representation to the JFO to serve as a Senior Federal Official within the JFO Coordination Group. Support agencies may also be represented, as needed. b. The primary agency is part of the Unified Command, as defined by the NIMS, and coordinates Federal radiological response activities at appropriate field facilities. Appropriate field facilities may include a JFO, Incident Command Post, EOC, Emergency Operations Facility, Emergency Control Center, etc. 4. Other Radiological Incidents: The primary agency coordinates Federal response operations at a designated field facility. Support agencies may also be represented, as needed. 5. Response Functions: Primary radiological response functions are addressed in this section. An overview of specific DHS and primary agency response functions is provided in Table 2. Table 2: DHS and primary agency response functions overview 6. Response Function Incidents of Critical Significance Other Radiological Incidents a. Coordinate actions of Federal agencies related to the overall response. DHS Primary agency b. Coordinate Federal activities related to response and recovery of the radiological aspects of an incident. DHS and primary agency Primary agency 21 OCTOBER 2013

38 c. Coordinate incident security. DHS and primary agency Primary agency d. Ensure coordination of technical data (collection, analysis, storage, and dissemination). DHS and primary agency Primary agency e. Ensure Federal protective action recommendations are developed and provide advice and assistance to State, and local governments. DHS and primary agency Primary agency f. Coordinate release of Federal information to the public. DHS Primary agency g. Coordinate release of Federal information to Congress. DHS Primary agency h. Keep the White House informed on aspects of an incident. DHS Primary agency i. Ensure coordination of demobilization of Federal assets. DHS Primary agency 7. Response Coordination a. Federal Agency Coordination Incidents of Critical Significance: DHS is responsible for the overall coordination of Incidents of National Significance using elements described in the NRP Base Plan concept of operations. b. Other Radiological Incidents 1) The agency with primary responsibility for coordinating the Federal response to a radiological incident serves as the primary agency. 2) The primary agency coordinates the actions of Federal agencies related to the incident utilizing this annex, agency-specific plans, and/or the NCP, as appropriate. 3) Support agencies provide technical and resource support, as requested by the primary agency. 22 OCTOBER 2013

39 4) The primary agency may establish a field facility; assist State, and local response organizations; monitor and support owner/operator activities (when there is an owner or operator); provide technical support to the owner/operator, if requested; and serve as the principal Federal source of information about incident conditions. 8. Coordinating Radiological Aspects of an Incident Incidents of Critical Significance a. DHS and the primary agency coordinate Federal activities related to responding to and recovering from the radiological aspects of an incident. They are assisted by support agencies, as requested. b. The primary agency provides a hazard assessment of conditions having significant impact and ensures measures are taken to mitigate the potential consequences. c. Other Radiological Incidents The primary agency coordinates Federal activities related to response and recovery of the radiological aspects of an incident, assisted by support agencies, as requested. 9. Incident Security Coordination Incidents of Critical Significance: a. DHS and the primary agency are responsible for coordinating security activities related to Federal response operations. b. Other Radiological Incidents The primary agency coordinates security activities related to Federal response operations. 10. Incident Security Coordination (Continued) Incidents of Critical Significance and Other Radiological Incidents a. DOD, DOE, or NASA, as the appropriate primary agency, may establish NDAs or NSAs to safeguard classified information and/or restricted data, or equipment and material, and place non-federal lands under Federal control for the duration of the incident. DOD, DOE, or NASA, as appropriate, coordinates security in and around these locations, as necessary. 23 OCTOBER 2013

40 b. For incidents at other Federal or private facilities, the owner/operator provides security within the facility boundaries. If a release of radioactive material occurs beyond the facility boundaries, State, local, or tribal governments provide security for the release area. c. State, and local governments provide security for radiological incidents occurring on public lands (e.g., a transportation incident). d. If needed, ESF - 13 Public Safety and Security may be activated to provide supplemental security resources and capabilities. 11. Technical Data Management Incidents of Critical Significance a. DHS and the primary agency approve the release of data to State, and local governments. b. For incidents involving terrorism, the primary agency consults with other members of the JFO Coordination Group as issues arise regarding the sharing of sensitive information needed, on a need-to-know basis, for responder and public safety. c. DHS and the primary agency, in consultation with the JFO Coordination Group and State, and local governments, determine if the severity of an incident warrants a request for Nuclear Incident Response Team (NIRT) assets. d. The IMAAC is responsible for production, coordination, and dissemination of consequence predictions for an airborne hazardous material release. The IMAAC generates the single Federal prediction of atmospheric dispersions and their consequences utilizing the best available resources from the Federal Government. e. Other Radiological Incidents The primary agency authorizes the release of data to State, county, and local, governments. f. The primary agency oversees the collection, analysis, storage, and dissemination of technical data through the entire process. 24 OCTOBER 2013

41 g. The primary agency is responsible for ensuring the sharing of technical data, including outputs from the FRMAC, the Advisory Team, and the IMAAC, with appropriate response organizations. h. Federal monitoring and assessment activities are coordinated with State, and local governments. Federal agency plans and procedures for implementing this activity are designed to be compatible with the radiological emergency planning requirements for State and local governments, specific facilities, and existing memorandums of understanding and interagency agreements. i. Prior to the on-scene arrival of the primary agency, Federal first responders may provide radiological monitoring and assessment data to State, and local governments as requested in support of protective action decision making. Federal first responders also begin collecting data for transmission to the primary agency. If a FRMAC is established, the primary agency provides a mechanism for transmitting data to and from the FRMAC. Prior to the initiation of FRMAC operations, Federal first responders coordinate radiological monitoring and assessment data with the DOE Consequence Management Home Team (CMHT) or the Consequence Management Response Team (CMRT). (Note: A CMHT provides a reach-back capability to support the CMRT. The CMRT functions as an advance element of the FRMAC to establish contact with on-scene responders to coordinate Federal radiological monitoring and assessment activities.) j. DOE and other participating Federal agencies learn of an emergency when they are alerted to a possible problem or receive a request for radiological assistance. DOE maintains national and regional coordination offices as points of access to Federal radiological emergency assistance. Requests for Radiological Assessment Program (RAP) teams are generally directed to the appropriate DOE Regional Coordinating Office. Additional requests for Federal radiological monitoring and assessment go directly to DOE s EOC in Washington, DC. When other agencies receive requests for Federal radiological monitoring and assessment assistance, they notify the DOE EOC. 25 OCTOBER 2013

42 k. DOE may respond to a State or primary agency request for assistance by dispatching a RAP team. If the situation requires more assistance than a RAP team can provide, DOE alerts or activates additional resources. These resources can include the establishment of a FRMAC as the coordination center for Federal radiological assessment activities. DOE may respond with additional resources including the Aerial Measurement System (AMS) to provide wide-area radiation monitoring, Radiation Emergency Assistance Center/Training Site medical advisory teams, National Atmospheric Release Advisory Center support, or if the accident involves a US nuclear weapon, the Accident Response Group. Federal and State agencies are encouraged to collocate their radiological assessment activities. Some participating Federal agencies have radiological planning and emergency responsibilities as part of their statutory authority, as well as established working relationships with State counterpart agencies. The monitoring and assessment activity, coordinated by DOE, does not alter these responsibilities but complements them by providing for coordination of the initial Federal radiological monitoring and assessment response activity. l. Responsibility for coordinating radiological monitoring and assessment activities may transition to EPA at a mutually agreeable time, and after consultation with State, and local governments, the primary agency, and the JFO Coordination Group. 12. Protective Action Recommendations Incidents of Critical Significance: a. DHS and the primary agency oversee the development of Federal Protective Action Recommendations and provide advice and assistance to State, and local governments. Federal Protective Action Recommendations are developed by the Advisory Team, in conjunction with the primary agency. Federal Protective Action Recommendations may include advice and assistance on measures to avoid or reduce exposure of the public to radiation from a release of radioactive material. This includes advice on emergency actions such as sheltering, evacuation, and prophylactic use of potassium iodide. It also includes advice on long-term measures, such as restriction of food, temporary relocation, or permanent resettlement, to avoid or minimize exposure to 26 OCTOBER 2013

43 residual radiation or exposure through the ingestion pathway. b. Other Radiological Incidents The primary agency, in consultation with the Advisory Team, develops and provides Protective Action Recommendations. c. Incidents of Critical Significance and Other Radiological Incidents: State, and local governments are responsible for implementing protective actions as they deem appropriate. 13. Public Information Coordination Incidents of Critical Significance and Other Radiological Incidents a. DHS, in consultation with other agencies and the JFO Coordination Group oversees and manages the establishment of a JIC, if required. b. Other Radiological Incidents The primary agency may establish a JIC depending on the needs of the incident response. c. Incidents of Critical Significance and Other Radiological Incidents 1) Owners/operators and Federal, State, local, and other relevant information sources coordinate public information to the extent practical with the JIC. Communication with the public is accomplished in accordance with procedures outlined in the ESF - 15 External Affairs Annex and the Public Affairs Support Annex. 2) It may be necessary to release Federal information regarding PH and safety. In this instance, Federal agencies coordinate with the primary agency and State, and local governments in advance, or as soon as possible after the information is released. 14. Congressional Coordination Incidents of Critical Significance: a. DHS coordinates Federal responses to congressional requests for information. Points of contact for this function are the congressional liaison officers. Federal agency congressional liaison officers and congressional staffs 27 OCTOBER 2013

44 seeking site-specific information about an incident should contact the DHS Office of Legislative Affairs and the primary agency. While Congress may request information directly from any Federal agency, any agency responding to such requests shall inform DHS and the primary agency. b. Other Radiological Incidents The primary agency is responsible for congressional coordination, consulting with DHS as required. 15. White House Coordination Incidents of Critical Significance a. DHS submits reports to the President and keeps the White House informed of aspects of the incident. While the White House may request information directly from any Federal agency, any agency responding to such requests must promptly inform DHS and the primary agency. b. Other Radiological Incidents: The primary agency is responsible for any necessary White House coordination, consulting with DHS as requested. These actions can take place during the transition from response to recovery. 16. Deactivation/Demobilization Coordination Incidents of Critical Significance: a. DHS and the primary agency, in consultation with the JFO Coordination Group and State, and local governments, develop plans to demobilize the Federal presence. b. Other Radiological Incidents The primary agency discontinues incident operations when a centralized Federal coordination presence is no longer required, or when its statutory responsibilities are fulfilled. Prior to discontinuing operations, the primary agency coordinates this decision with each Federal agency and State, and local governments. 17. International Coordination Incidents of Critical Significance and Other Radiological Incidents a. In the event of an actual or potential environmental impact upon the United States or its possessions, territories, or territorial waters from a radiological emergency originating on foreign soil or, conversely, a domestic incident with an actual or potential foreign impact, DHS and the primary agency immediately inform the Department of State (DOS), 28 OCTOBER 2013

45 which is responsible for official interactions with foreign governments. In either case, (foreign incident with domestic impact, or vice versa), the primary agency consults with DHS, and DHS makes a determination on whether it is an Incident of Critical Significance. DHS and the primary agency keep DOS informed of Federal incident management activities. b. DOS coordinates notification and information-gathering activities with foreign governments, except in cases where existing bilateral agreements permit direct communication. Where the primary agency has existing bilateral agreements permitting direct exchange of information, the primary agency keeps DOS informed of consultations with their foreign counterparts. DHS and the primary agency ensure any offers of assistance to, or requests from, foreign governments are coordinated with DOS. c. The National Oceanic and Atmospheric Administration is the point of interaction with the hydro meteorological services of other countries. International response activities are accomplished in accordance with the International Coordination Support Annex. 18. Victim Decontamination/Population Monitoring Incidents of Critical Significance and Other Radiological Incidents a. External monitoring and decontamination of possibly affected victims are accomplished locally and are the responsibility of State, and local governments. Federal resources are provided at the request of, and in support of, the affected State(s). HHS, through ESF - 08 and in consultation with the primary agency, coordinates Federal support for external monitoring of people and decontamination. b. HHS assists and supports State and local governments in performing monitoring for internal contamination and administering available pharmaceuticals for internal decontamination, as deemed necessary by State health officials. 29 OCTOBER 2013

46 c. HHS assists local and State health departments in establishing a registry of potentially exposed individuals, perform dose reconstruction, and conduct long-term monitoring of this population for potential long-term health effects. 19. Other Federal Resource Support: For Stafford Act or Federal-to- Federal support incidents, DHS/EPR/FEMA coordinates the provision of Federal resources and assistance to affected State, and local governments as part of the JFO Operations Section or other appropriate location established by DHS/EPR/FEMA. D. Recovery 1. When the DHS is coordinating the Federal response, it coordinates, in concert with State, tribal, and local governments, overall Federal recovery pursuant to the NRF. The coordinating agency maintains responsibility for managing the Federal technical radiological cleanup activities in accordance with its statutory authorities, responsibilities and NRF mechanisms. While retaining technical lead for these activities, the coordinating agency may request support from a cooperating agency having cleanup/recovery experience and capabilities (e.g., EPA, U.S. Army Corps of Engineers (USACE)). 2. State, and local governments primarily are responsible for planning the recovery of the affected area (the term recovery, as used here, encompasses any action dedicated to the continued protection of the public and resumption of normal activities in the affected area). Recovery planning is initiated at the request of the State, local, or tribal governments, and generally does not take place until the initiating conditions of the incident have stabilized and immediate actions to protect PH, safety, and property are accomplished. Upon request, the Federal government assists State, and local governments develop and execute recovery plans. 3. Private owners/operators have primary responsibility for recovery planning activities and eventual cleanup within their facility boundaries and may have responsibilities for recovery activities outside their facility under applicable legal obligations (e.g., contractual, licensee, CERCLA). 30 OCTOBER 2013

47 4. The DOE FRMAC Director works closely with the FRMAC s Senior EPA representative to facilitate a smooth transition of the Federal radiological monitoring and assessment coordination responsibility to EPA at a mutually agreeable time, and after consultation with DHS, the Unified Coordination Group, and State, tribal, and local governments. The following conditions are intended to be met prior to transfer: 5. The immediate emergency condition is stabilized; 6. Offsite releases of radioactive material have ceased, and there is little or no potential for further unintentional offsite releases; 7. The offsite radiological conditions are characterized and the immediate consequences are assessed; 8. An initial long-range monitoring plan has been developed in conjunction with the affected State, and local governments and appropriate Federal agencies; and 9. EPA has received adequate assurances from the other Federal agencies. They are committing the required resources, personnel, and funds for the duration of the Federal response. 10. Radiological monitoring and assessment activities are normally terminated when DHS, in consultation with the primary agency, other participating agencies, and State, and local governments, determines: 11. There is no longer a threat to PH and safety or the environment; 12. State, tribal and local resources are adequate for the situation; and 13. There is mutual agreement among the agencies involved to terminate monitoring and assessment. E. Federal Assets Available Upon Request by the Primary agency or DHS FRMAC 1. DOE is responsible for developing and maintaining FRMAC policies and procedures, determining FRMAC composition, and maintaining FRMAC operational readiness. The FRMAC is established at or near the incident location in coordination with DHS, the primary agency, other Federal agencies, and State, and local authorities. A FRMAC normally includes representation from DOE, EPA, the Department of Commerce, the National Communications System 31 OCTOBER 2013

48 2. (DHS/Information Analysis and Infrastructure Protection/National Communications System), USACE, and other as the primary agency, DOE, through the FRMAC or DOE CMHT and CMRT, coordinates radiological monitoring and assessment activities for the initial phases of the response. When the FRMAC is transferred to the EPA, they assume responsibility for coordination of radiological monitoring and assessment activities. 3. The EPA Radiological Emergency Response Team (RERT) provides resources, including personnel, specialized equipment, technical expertise, and laboratory services to aid coordinating and cooperating agencies and State, tribal, and local response organizations in protecting the public and the environment from unnecessary exposure to ionizing radiation from radiological incidents. The RERT is a designated Special Team under the NCP. It may become part of the FRMAC if one is established. F. Advisory Team 1. The Advisory Team includes representatives from DHS, EPA, the USDA, the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and other Federal agencies. The Advisory Team develops coordinated advice and recommendations for DHS, the JFO Coordination Group, the primary agency, and State, and local governments concerning environmental, food health, and animal health matters. 2. The Advisory Team selects a chair for the Team. 3. The Advisory Team provides recommendations in matters related to the following: 4. Environmental assessments (field monitoring) required for developing recommendations with advice from State, and local governments and/or the FRMAC senior Monitoring Manager; 5. Protective Action Guides and their application to the emergency; 6. Protective Action Recommendations using data and assessment from the FRMAC; 7. Protective actions to prevent or minimize contamination of milk, food, and water, and to prevent or minimize exposure through ingestion; 32 OCTOBER 2013

49 8. Recommendations regarding the disposition of contaminated livestock, poultry, and contaminated foods, especially perishable commodities (e.g., meat in processing plants); 9. Recommendations for minimizing losses of agricultural resources from radiation effects; 10. Availability of food, animal feed, and water supply inspection programs to assure wholesomeness; 11. Relocation, reentry, and other radiation protection measures prior to recovery; 12. Recommendations for recovery, return, and cleanup issues; 13. Health and safety advice or information for the public and for workers; 14. Estimated effects of radioactive releases on human health and the environment; and 15. Other matters, as requested by the primary agency. G. DOE Radiological Assistance Program, Emergency Management Teams, and NIRT Assets: 1. RAP teams are located at DOE operations offices, national laboratories, and some area offices. They can be dispatched to a radiological incident by the DOE regional coordinating offices responding to a radiological incident. 2. Additional DOE planning and response teams and capabilities are located at various DOE facilities throughout the country and can be dispatched, as needed, to a radiological incident. 33 OCTOBER 2013

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51 / APPENDIX 1 CRCSPECIFICATIONS APPENDIX 1: CRC SPECIFICATIONS A. A radiation incident involving mass casualties will require planners to establish one or more population monitoring and decontamination facilities (or reception centers ) to assess people for exposure, contamination, and the need for decontamination or other medical follow-up. Some CRCs should be established at or near shelters operated by the ARC. B. These reception centers must include staff members and equipment capable of 1. Detecting contamination through beta/gamma portal monitors. 2. Monitoring for general contamination using hand-held instruments. 3. Fielding questions and addressing concerns. 4. Distributing event and follow-up information. C. This appendix describes some of the features and requirement for CRCs. You can compare the description with what is already included in your PH emergency plan for setting up a Point Of Distribution (POD). D. Facility Description 1. You need to evaluate facilities or sites in your community which could potentially serve as reception centers. You should consider a. Size. b. Location. c. Adequate restroom facilities. d. Accommodations for people with disabilities. e. Environmental control (against excessive heat or cold). f. Adequate access and regress control (in case of emergency evacuation). 2. To process about 1,000 people per hour, the facility should have about 5,000 square feet of covered space and 8,000 square feet of uncovered space. The chosen locations must have definable and controllable entries and exits. Choosing an all-weather facility, like a nearby covered sports arena or convention center, is ideal. However, depending on the circumstances and weather, a nearby 35 OCTOBER 2013

52 / APPENDIX 1 CRCSPECIFICATIONS E. Staffing park or large parking lot will also suffice. You should establish agreements in advance with facility or site owners and operators. a. For example, see POD Operations Manual, Philadelphia Department of PH, Division of Disease Control, Emergency Preparedness and Bioterrorism Program, Available from b. Also see archived CDC Webcasts, Mass Antibiotic Dispensing: Streamlining POD Design and Operations, available from and Mass Antibiotic Dispensing: Taking the Guesswork out of POD Design, available from www2a.cdc.gov/phtn/poddesign/default.asp 1. The CRCs must have sufficient staff, both technical and nontechnical, to manage the center for up to several days or weeks. Technical staff members who are competent in the use of radiological survey equipment must be available for monitoring, but having additional staffers for processing and decontamination may also be critical. As federal personnel and others arrive, they should be able to supplement staffing at these centers. One or more clinicians will likely be needed at each center to assess and refer individuals who need medical follow-up or to administer pharmaceutical countermeasures. 2. Many community PH departments have established MRC with medical and non-medical volunteers to assist in times of public health emergency. MRC volunteers are usually trained to staff PODs, and they can also assist with staffing CRCs. It is prudent for MRCs to also recruit health physicists or other radiation safety professionals as volunteers. 3. Consider the following staffing needs for each shift. For certain positions (e.g., greeters), consider shorter (4 6 hour) shifts to minimize physical and mental fatigue. The following staffing requirements are recommended for processing 1,000 individuals per hour: a. Facility Director/Assistant (2 persons per shift). b. Greeters (2 greeters per 1,000 people per hour). Greeters represent the cultural diversity of the community and should 36 OCTOBER 2013

53 / APPENDIX 1 CRCSPECIFICATIONS be able to converse in languages commonly spoken there c. Uniformed security officers (police/national Guard). d. On-site media relations staff. e. Crisis (grief) counselors (5). f. Hand-held monitoring stations (10). g. Line staff (2 each station, 20 total). h. Radiation monitoring staff (1 each station, 20 total). i. Escort staff (1 each station, 10 total). j. Beta/gamma portal monitoring stations (10). k. Line staff (1 each station, 10 total). l. Radiation monitoring staff ( 2 each station, 20 total). m. Escort staff (1 each station, 10 total). n. Registry staff (25). o. Nursing/Medical referral stations (10). Clinicians will likely be needed to assess and refer individuals who need medical follow-up. Use same as already planned for POD, Neighborhood Emergency Health Centers, or alternate care centers in your community. What medical support is needed will depend on the nature and scope of the incident. 4. At least one ambulance with emergency medical technicians and paramedics should be available to transfer individuals who are referred by the medical team to hospitals. In addition, it is prudent to plan for a number of buses (and bus drivers) who can provide transportation on a priority schedule to and from the CRCs for those who need such transportation. a. For general information about the MRC program, see b. To locate an MRC in your area, see Kramer, Gary H, Capello, Kevin, Hauck, Barry M, The HML s New Field Deployable, High-Resolution Whole Body Counter, Health 37 OCTOBER 2013

54 / APPENDIX 1 CRCSPECIFICATIONS F. Equipment Phys. 89(5 Suppl):S60-8, November c. Handbook for Responding to a RDD. First Responder s Guide the First 12 Hours, d. Conference of Radiation Control Program Directors, Inc. (CRCPD), September e. The Federal Advisory Team develops coordinated advice and recommendations to the coordinating agencies and state and local governments and includes representatives from the CDC, the FDA, the EPA, USDA, the DHS, and other Federal agencies as needed. 1. Portable radiation monitoring equipment will be provided by supporting agencies and available for use at each CRC. Use of additional monitoring equipment, if demand exceeds available resources provided, may be possible if negotiated with other supporting agencies, such as MHUMC and/or Savannah Fire, by special agreement and on an as needed basis. 2. The following list of monitoring equipment inventory from each respective agency will be available for use at one or more CRCs. a. MHUMC Manufacturer Model Measurement Description Quantity Thermo Scientific Rad Eye B20- ER Alpha, beta, gamma, x-ray Hand held 6 Thermo Scientific Rad Eye G Gamma Hand held Dose/Rate 7 38 OCTOBER 2013

55 / APPENDIX 1 CRCSPECIFICATIONS b. Coastal Health District Manufacturer Model Measurement Description Quantity Thermo Scientific Rad Eye B20-ER Alpha, beta, gamma, X-ray Hand held 10 Thermo Scientific Rad Eye G Gamma Hand held Dose/Rate 16 Thermo Scientific Rad Eye PRD- ER Gamma Hand held 6 Thermo Scientific TPM-903B Gamma Transportable/ Portable 2 c. CRC Staffing Matrix: 1) The following staffing requirements are recommended for processing 1,000 individuals per hour: Staffing Position 8 Hour Shifts Facility Director 2 persons per shift Security Officers 2 persons per shift Risk Communicator (Media Relations) 1 persons per shift Hand-held Monitoring Stations Line Staff 10 Stations X 2 persons per station= 20 persons per shift Hand-held Monitoring Stations Monitoring Staff 10 Stations X 1 persons per station= 10 persons Hand-held Monitoring Stations Escort Staff 10 Stations X 1 persons per station= 10 persons Beta/gamma Portal Monitoring Stations Line Staff 10 Stations X 2 persons per station= 20 persons per shift Beta/gamma Portal Monitoring Stations Monitoring Staff 10 Stations X 1 persons per station= 10 persons Beta/gamma Portal Monitoring Stations Escort Staff 10 Stations X 1 persons per station= 10 persons Registry Staff 25 persons per shift First Aid 5 persons per shift Washing Station 5 persons Nursing/Medical Referral Stations 10 persons per shift and clinicians Crisis/Grief Counseling 5 persons per shift Discharge Station 10 persons Total Staffing Required 145 persons per shift 39 OCTOBER 2013

56 / APPENDIX 1 CRCSPECIFICATIONS 2) Potential sites for CRCs in Savannah, GA a) Sports/Multi-Purpose Arenas (i) Tiger Arena (Savannah State): 3219 College St, Savannah, GA 31404, USA tab=basketball&path=mbball (ii) (iii) (iv) (v) Savannah Civic Center/Martin Luther King Arena (Downtown): 25,000 sq. ft. ccenter.nsf/a481b26274a85edf85256b dbaa/3c06d2d804f4fd3b85256b4 3005a5792?OpenDocument Supergoose Sports Arena: 28,000 sq. ft Alumni Arena Armstrong Atlantic University (Southside area) 82,000 sq.ft. mniarena Lisa Sweany, Athletic Director Chad Jackson, Communications Director Savannah International Trade and Convention Center (Downtown) One International Drive, PO Box 248 Savannah, Georgia verview/ OCTOBER 2013

57 / APPENDIX 1 CRCSPECIFICATIONS b) Farmer s Markets (i) (ii) (iii) Forsyth Farmers Market Bull St. and Park Ave (Chatham County) Location: South end of Forsyth Park between the basketball and tennis courts Hours: Sat. 9 a.m. 1 p.m. (April 2 November 19) forsythfarmersmarket@gmail.com Savannah State Farmers Market 701 U.S. Highway 80 West Savannah, GA (Chatham County) Hours: (Year /round) Tel: (912) khamilt@agr.state.ga.us WEST BAY Farmers Market 2118 W. Bay St. Savannah, GA (Chatham County) Hours: Sat. 9 a.m. 1:15 p.m. Tel: (912) bba1259@aol.com c) Alternatives (i) Gulfstream Aerospace Corporation 500 Gulfstream Road Savannah, Georgia ah.htm (912) OCTOBER 2013

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59 / APPENDIX 2 RADIOLOGICAL SCREENING CRITERIA EXTERNAL CONTAMINATION APPENDIX 2: RADIOLOGICAL SCREENING CRITERIA EXTERNAL CONTAMINATION A. Radiological screening for external contamination is performed to assess the amount of radioactive materials on the skin and clothing. These materials can irradiate the body when beta and gamma-emitting radionuclides are present. If the radioactive material remains on skin or clothing, it could be released to the air and inhaled, or be incidentally ingested, resulting in internal contamination. Internal contamination is particularly significant in the case of alpha emitting radionuclides. B. External contamination on individuals can also be spread, resulting in cross-contamination or the spreading of radioactive materials to other places where they should not be. Cross contamination is a PH concern, although it is secondary to immediate concerns for people s health and safety. C. In this Appendix, a number of benchmark screening criteria and their technical bases are briefly described. This is followed by recommendations on how to select particular screening criteria to best serve PH in a variety of circumstances. D. The information in this appendix is meant for PH planners, not first responders. It should be considered and discussed with health physics experts in your state radiation control and PH programs during the planning process, prior to any incidents. E. Benchmark Screening Criteria 1. This Appendix will describe the following documents: a. Contamination Monitoring Standard for a Portal Monitor Used for Radiological Emergency Response, Federal Emergency Management Agency, FEMA- REP-21, March b. Contamination Monitoring Guidance for Portable Instruments Used for Radiological Emergency Response to NPP Accidents, Federal Emergency Management Agency, FEMA-REP-22, October c. Key Elements of Preparing Emergency Responders for Nuclear and Radiological Terrorism, National Council on Radiation Protection and Measurements (NCRP) Commentary No. 19, December OCTOBER 2013

60 / APPENDIX 2 RADIOLOGICAL SCREENING CRITERIA EXTERNAL CONTAMINATION d. Handbook for Responding to a RDD. First Responder s Guide the First 12 Hours, CRCPD, September e. Manual for First Responders to a Radiological Emergency, International Atomic Energy Agency (IAEA), October 2006 f. Manual of Protective Action Guides and Protective Actions for Nuclear Incidents, EPA, EPA-400-R , May The first two documents, FEMA REP- and REP-, have associated technical background documents discussing the technical bases and assumptions of the guidance. These two guidance documents are currently being combined in a revised guidance document. They address radiation emergencies involving NPP facilities. They do not address terrorism incidents. The remaining documents do address terrorism, with CRCPD specifically focusing on RDD incidents. The EPA document is currently being updated, but the recommended contamination screening levels are not expected to change and will be described here. F. Radiation Control Zones 1. Although this topic does not directly deal with population monitoring, it does affect the manner in which people at the scene are directed. FEMA REP documents do not address this topic, but the NCRP, CRCPD, and IAEA documents are consistent in the manner in which they delineate radiation control zones at the scene. The three documents identify two major zones: a. Inner perimeters with radiation levels exceeding 100 msy/h (10 R/h) and where only lifesaving or other mission-critical activities should be performed with very short (few minutes) stay times. b. Outer perimeter with radiation levels exceeding 0.1 msv/h (10 mr/h) from which people are evacuated, the area is isolated, and controlled entry is implemented to allow in only first responders with appropriate personal protection equipment. 2. CRCPD recommends the outer perimeter should be set at lower than 0 mr/h if it is practical (i.e., the area does not become too large or too distant from the epicenter of the blast). 44 OCTOBER 2013

61 / APPENDIX 2 RADIOLOGICAL SCREENING CRITERIA EXTERNAL CONTAMINATION 3. CRCPD also states responders may define additional boundaries, if needed, at 00 mr/h and 000 mr/h. a. People (Skin and Clothing) Screening Criteria 4. Both the FEMA REP documents and the NCRP recognize two health-based concerns: a. Deterministic effects acute exudative radiodermatitis has the limiting radiation dose threshold. b. Long-term stochastic effects skin cancer. FEMA also defines two types of contamination, loose and fixed. Loose contamination can be removed by washing or changing clothes. FEMA assumes, on average, people will be able to bathe and remove loose contamination within 6 hours of the incident. 5. Fixed skin contamination will remain even after bathing and will be removed by natural processes within weeks. 6. Concerning acute effects, FEMA sets a limit of 0. µci (.7 kbq) for fixed contamination on a spot of skin. When contamination is mixed (loose-plus-fixed contamination), FEMA sets a higher limit of.0 µci ( 7 kbq) for spot contamination. 7. Concerning the stochastic effects, FEMA sets a limit of 74 µci (.7 MBq) for fixed contamination over the body, regardless of distribution. If uniformly distributed over the surface of an adult body, this corresponds to µci/cm, which is equal to 50 Bq/cm or 9000 dpm/cm. When contamination is mixed, a higher limit of 740 µci ( 7 MBq) is set for distributed contamination. For an adult, this is equal to 0.04 µci/cm, which is equal to.5 kbq/cm or 90,000 dpm/cm. 8. Individuals with spot contamination on the skin exceeding. x 06 dpm have priority for decontamination. This equals FEMA s µci ( 7 kbq) limit for mixed contamination described above. 45 OCTOBER 2013

62 / APPENDIX 2 RADIOLOGICAL SCREENING CRITERIA EXTERNAL CONTAMINATION 9. As per the NCRP, decontamination procedures should strive to reduce surface contamination to below the following limits: a. 2.2 x 105 dpm (3.7 kbq) on any one spot. b. 10,000 dpm/cm2 (167 Bq/cm2) surface body contamination. 10. NCRP contamination guides numerically equal FEMA s limits for fixed contamination. The language is slightly different in the two documents. Whereas FEMA sets these values as upper limits, NCRP recommends the decontamination procedures should strive to meet or exceed these guides. 11. Contamination survey equipment does not measure in units of surface activity such as µci or kbq/cm. The instruments typically read in units of counts per minute (cpm). For first responders, the screening criteria should be given in operational units. The conversion to operational units is made considering the sensitive area of the probe and the probe counting efficiency for the particular type of radionuclide. Operational units may vary by orders of magnitude between the various available probes. 12. FEMA evaluated several instruments and decided to recommend a single value, equivalent to the response for the least sensitive instrument (CD V-700 with a standard detector). This value is 00 cpm above background. Using this criterion with more sensitive instrument combinations will provide an additional level of protection. In the Background Information document for REP- Guidance, FEMA states the following: a. CD V-700s: have been retrofitted with a pancake detector, to be set at 1,000 cpm and 10,000 cpm for fixed and looseplus-fixed contamination, respectively. b. Non CD V-700: instruments with pancake detectors, criteria of 10,000 cpm and 100,000 cpm could be used for fixed and loose-plus-fixed contamination, respectively. 13. Generally, the fixed contamination criterion is applied to individuals who have showered and changed clothes. The criterion for looseplus-fixed contamination is applied to those who have not yet washed or changed clothes. 46 OCTOBER 2013

63 / APPENDIX 2 RADIOLOGICAL SCREENING CRITERIA EXTERNAL CONTAMINATION 14. NCRP Commentary 19 values correspond to FEMA s values for fixed contamination. NCRP, however, does not provide operational units. Users would have to make such calculations for their own types of instruments. 15. Both NCRP and FEMA documents assume a mixture of radionuclides from a nuclear reactor mix. 16. FEMA REP- only document addressing portal monitors and suggests one microcurie ( µci) as the Standard of Detectability for beta gamma activity. 17. The CRCPD Handbook focuses on RDD incidents. The screening criteria given in the CRCPD Handbook are in operational units and assume using a modern Geiger-Mueller (GM) pancake probe. CRCPD states the following: a. With contamination levels up to 1,000 cpm, people can be instructed to go home and shower. This level is equal2 to 440 dpm/cm2, compared to the NCRP value of 10,000 dpm/cm2. b. In case of a large incident or if adequate decontamination resources are not available, the release level can be increased to 10,000 cpm (0.05 mr/h using a gamma detector). This is equal to 4,400 dpm/cm2, compared to the NCRP value of 10,000 dpm/cm The CRCPD Handbook also recommends minimizing the spread of contamination at hospitals, by decontaminating to levels below 1,000 cpm by using a pancake GM, but only if such decontamination efforts do not interfere with patient medical treatment. 19. Assuming a probe area of 15 cm2 and 15% counting efficiency, The CRCPD further states: establishing higher decontamination limits (i.e., higher than 10,000 cpm) may be necessary, depending on the number of patients and the decontamination resources available. 20. The IAEA Manual recommends a somewhat different approach. A single dose rate criterion of µsv/h (0. 1mrem/h) measured at 10 cm from the body is provided. This particular criterion can only be used to assess skin or clothing contamination from strong gamma emitters. 47 OCTOBER 2013

64 / APPENDIX 2 RADIOLOGICAL SCREENING CRITERIA EXTERNAL CONTAMINATION 21. The IAEA also provides the following surface activity criteria, and the IAEA is the only document providing specific population screening criteria for alpha contamination: a. >10,000 Bq/cm2 beta/gamma contamination. b. > 1,000 Bq/cm2 for alpha contamination. 22. Note: the IAEA value of 10,000 Bq/cm for beta/gamma contamination equals 600,000 dpm/ cm, compared to the NCRP decontamination value of 0,000 dpm/cm on any one spot and 10,000 dpm/cm body surface contamination. 23. The IAEA Manual states- the following were considered in developing these criteria: a. Important isotopes. b. Members of the public, including children and pregnant women. c. Inadvertent ingestion of contamination from the skin. d. External dose from skin contamination. e. Skin contamination as an indicator of inhalation dose. 24. The EPA Protective Action Guides (also referred to as EPA-400) was published in 1992 before any of the other documents discussed in this Appendix. It recommends monitoring and decontamination facilities be established in low background areas. These are areas with gamma exposure rates less than 0. 1 mr/h. 25. In major radiation incidents, emergency contamination screening stations may need to be set up in areas not qualifying as low background area. Gamma exposure rates in these areas should be less than 5 mr/h. 26. In either case, EPA s recommended surface screening levels for persons is set at twice existing background. Corresponding levels, expressed in units related to particular survey instruments, may be used for convenience. The EPA screening levels are derived primarily on the basis of what are considered easily measurable radiation levels using portable instruments. Levels higher than twice existing background (not to exceed 0. mr/h) may be used to speed the monitoring process in very low background areas. 48 OCTOBER 2013

65 / APPENDIX 2 RADIOLOGICAL SCREENING CRITERIA EXTERNAL CONTAMINATION 27. This EPA document is currently being revised, but the recommended surface contamination levels are not expected to change. G. Selecting a Screening Criterion 1. As evident from the preceding discussion, there are a large number of factors to consider in deciding on a screening criterion. The guidance documents consider health-based criteria for establishing limits. CRCPD screening values are somewhat lower than those recommended by FEMA and NCRP. This is due to consideration given to cross-contamination issues, which do not necessarily present a health concern. However, public perception can cause anxiety, lack of confidence, and disruption of other services which could then affect the PH in a different way. 2. The initial screening criteria must focus on preventing acute health effects and must take into account the magnitude of the incident and availability of resources. The specific operational criteria provided to first responders must match the types of instruments they will be using. 3. The plan should also be flexible. It may be prudent to use higher screening criteria for people with their own personal transportation or those using transportation provided by emergency response authorities. On the other hand, using more restrictive criteria for people who plan to use uncontrolled public transportation may be warranted. 4. If the initial screening criterion is isolating an unmanageable number of people for decontamination, the criteria may have to be adjusted upwards. Conversely, if resources allow, a more restrictive criterion may be adopted. 5. In some circumstances, it may be practical to use physical location based on proximity to the incident site as a criterion for prioritizing the population in most urgent need of assistance with decontamination. Under those circumstances, assist those in the specified zone (without any initial screening) to decontaminate at the scene, and instruct people outside the zone to go home to selfdecontaminate. 6. As a result of these considerations, CDC does not recommend setting a fixed screening criterion to be applied to all people for all incidents, under all circumstances. The state radiation control authority, as state planners and decision makers, consider a range 49 OCTOBER 2013

66 / APPENDIX 2 RADIOLOGICAL SCREENING CRITERIA EXTERNAL CONTAMINATION of possible circumstances, keeping the following in mind: a. Population monitoring objectives as described in this planners guide. b. Specific radiation survey instruments your responders will be using (dose rate meters, portal monitors, specific types of surface contamination monitors). c. Staffing resources and size of the population you may be expected to process. d. Facilities and resources you have for offering on-the-scene monitoring and decontamination. e. Availability of other resources can increase or decrease available options. 7. The planning should be done in advance, allowing some room for flexibility. The emergency responders, however, must have very clear instructions to follow on the basis of your evaluation of the specific local circumstances. CDC is available to assist you in the planning process. In the aftermath of a radiological or nuclear incident, the Federal Advisory Team can assist you in establishing practicable screening criteria based on specific local circumstances. 50 OCTOBER 2013

67 / APPENDIX 3 RADIOLOGOICAL SCREENING CRITERIA INTERNAL CONTAMINATION APPENDIX 3: RADIOLOGICAL SCREENING CRITERIA INTERNAL CONTAMINATION A. Internal contamination occurs when people swallow or breathe in radioactive materials, or when radioactive materials enter the body through an open wound or are absorbed through the skin. Some types of radioactive materials stay in the body and are deposited in different body organs. Over time, the radioactive materials are eliminated from the body in blood, sweat, urine, and feces. This could take days, months, or years, depending on the type of radionuclides and their physical and biological half-lives. B. Having internal contamination does not necessarily mean the person is going to experience health problems. Every day, thousands of people in the United States receive diagnostic tests involving the administering of traces of short-lived internal radioactive materials on an outpatient basis, and they are released to go home after their procedures. C. If the amount of radioactive material is medically significant (this will be discussed later), the person may have an increased risk of developing cancer. In case of extremely high doses, internal contamination with radioactive material could be lethal. However, this is extremely rare. RDD incidents are likely to result in small (most likely inconsequential) amounts of internal contamination. D. When a person is internally contaminated, depending on the type of radioactive material he/she is contaminated with, certain medications can be administered to speed up the rate at which the radioactive material is eliminated from the body. Internal decontamination is a medical procedure and should only be performed at the order and under the guidance of a licensed physician. E. Information about the levels of internal contamination is important in deciding whether any or both of the following are warranted: 1. Medical intervention 2. Long-term health monitoring F. Decisions about medical intervention are time-sensitive, but decisions about long-term health monitoring can be made in a more deliberative fashion involving stakeholders. G. Regarding medical management of internally contaminated individuals, presently there is no national guidance or consensus on what internal contamination level would constitute a medically significant amount 51 OCTOBER 2013

68 / APPENDIX 3 RADIOLOGOICAL SCREENING CRITERIA INTERNAL CONTAMINATION warranting intervention. H. The amount of internal radioactive contamination is only one of many parameters a physician would evaluate in assessing the need for treatment. A person s age and general health and organ function (kidney, liver, lung, etc.) are among the information physicians would need to make their best medical judgment. I. The Medical Preparedness and Response Sub-Group of thedhs Working Group on RDD Preparedness provides the following recommendations for treatment of internal contamination: 1. For intakes less than one annual limit on intake (ALI), treatment should not be considered. 2. For intakes greater than 1 ALI, but less than 10 ALI, clinical judgment may dictate treatment. 3. For intakes greater than 10 ALI, treatment is highly recommended. J. The International Commission on Radiological Protection (ICRP) Publication 96 states:, Therapies for internal contamination are not recommended for general population use unless intakes are high. Generally, if the intake is < annual limit of intake (ALI), treatment is not usually needed, and if the intake is > 0 ALI, treatment is usually indicated, with the exception of potassium iodide. K. The ICRP 96 further states in the same paragraph, These treatments should be under the direction of a physician experienced in these matters, and should take individual patient factors into account. L. In a mass casualty incident, however, detailed medical evaluations for each person are unlikely. M. The amount of internal contamination also may not be known immediately. N. For gamma-emitting radionuclides, field-deployable instruments may be used to perform whole body counting capable of detecting medically significant amounts of internal contamination.6 Analysis of radioactivity in excreta (e.g., urine) by a clinically certified commercial laboratory or hospital can establish amounts of radioactive material in the body. Although the urine analysis can be performed fairly rapidly (within 4 hours), it takes some time for this information to be available for the affected and potentially affected population. Therefore, some prioritization scheme for analysis of samples will be necessary. This prioritization can be based in part on radiation measurements using field-deployable 52 OCTOBER 2013

69 / APPENDIX 3 RADIOLOGOICAL SCREENING CRITERIA INTERNAL CONTAMINATION instruments or on people s physical location at the time of the incident. O. External radiation monitoring can provide some indication of the extent of internal contamination. CRCPD recommends people with external contamination greater than 00,000 cpm (measured with a Geiger-Mueller pancake probe) should be identified as a priority for follow-up for internal contamination. In case of alpha-emitting radionuclides, only laboratory analysis can provide a definitive assessment. P. Furthermore, the physical location of people during the incident can be an additional indicator of the likelihood and magnitude of internal contamination. It may be necessary to recommend treatment for internal contamination for a subset of the affected population only on the basis of their location at the time of the incident. Q. As part of the planning process, PH authorities should consult with other experts and evaluate the need, relative effectiveness, logistical requirements or limitations, priority for administration of decorporation agents, potential prioritization schemes, and, most importantly, the decision-making process needed to make these clinical judgments in a mass casualty incident. R. CDC is available to assist you in the planning process. In the aftermath of a radiological or nuclear incident, assistance can be requested from the Federal Advisory Team through the Coordinating Agency. 53 OCTOBER 2013

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71 / APPENDIX 4 TRIAGE TAGS APPENDIX 4: TRIAGE TAGS County Health Department (Street Number) (City, State, Zip) (Telephone Number) Personal Information Name: Permanent Address: Gender/DOB/Age: Temporary Address: Phone: Cell Phone: Comments: Emergency Contact Name: Emergency Contact Phone: Emergency Contact Address: Vital Signs Time B/P Pulse Respiration Notes: Accident: Brief Description: Date/Time: Location: 55 OCTOBER 2013

72 / APPENDIX 4 TRIAGE TAGS Radiation Exposure External Radiation Types Estimated Exposure Time Dose Rate Whole Body Partial Body Prodromal symptoms of Acute Radiation Syndrome: Time/Date Vomiting Anorexia Tachycardia Nausea Headache Diarrhea Apathy Fever Surface Contamination: Identify Isotope(s): Body Part Contaminated area (shrapnel) Initial Count Decontamination performed? F/U Count Decontamination method and agent used: Biodosimetry Samples Obtained Date/Time Sent Where Nasal Smears (R&L) CBC (Complete Blood Count) CBC (Complete Blood Count) with diff & PLT Count Bioassay samples Comments 56 OCTOBER 2013

73 / APPENDIX 5 OPERATIONAL PROCEDURES FOR A RADIOLOGICAL EVENT APPENDIX 5: OPERATIONAL PROCEDURES FOR A RADIOLOGICAL EVENT CCHD In the event a radiation incident occurs endangering the health of the population, PH will be called upon to offer assistance. The County EH Manager, County Nurse Manager, and/or County Administrator will be contacted by the County EMA director. Once PH has been notified, the County EH Manager will report to the County EOC and will notify the CHD Director of EPR. The CHD Director of EP&R will notify The CHD Health Director and initiate operation of the District Operations Center if necessary. The County Nurse Manager and or County Administrator will notify and mobilize personnel and supplies to go to the designated CRC. The following supplies will be taken to the CRC: *Zip lock bags *Clip Boards *Nose Swabs *Sharpies *Triage forms *Masking Tape *Tables (3) *Pens *Tent *Information sheets for after care *Labels *Protocol/Procedure Manuals *Contact numbers for resources *Laptops (Supplies are not currently in stock but must be acquired by CCHD) At the reception center only people who have been decontaminated will be triaged and tested by PH staff. After decontamination, clerical staff will use triage forms to obtain information from those possibly affected by radiation. Labels will be prepared with name and date of birth. Information from the Triage form will be entered into an excel spreadsheet using the laptops. The exposed person will go to a PH station for testing as appropriate. The test will be put in a sealed zip lock bag and a label attached to the bag. PH staff will prepare specimens and ship to designated lab for testing if necessary. **Training for PH personnel is required and must be developed for CRC operations** 57 OCTOBER 2013

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75 / APPENDIX 6 CRC JOB ACTION SHEETS APPENDIX 6: CRC JOB ACTION SHEETS Initial Sorting Station Job Action Sheet This station is in the Contamination Control Zone. Workers must wear PPE assigned to them. Before Shift Report to the Staff Sign-In Area Collect assigned personal protective equipment (PPE), dosimetry devices, and radiation detection instruments Attend pre-shift briefing Report to Initial Sorting Station Manager to receive and review position assignment Review High Contamination Screening Job Aid During Shift Report any emergencies or injuries to your station manager IMMEDIATELY Wear assigned PPE and dosimetry devices As possible, avoid physical contact with arrivals to limit cross-contamination o If you touch someone, change your gloves or have them checked for contamination Assign ID numbers to people as they arrive Collect the following information as people arrive: o Name o Date of Birth o Last 4 digits of Social Security Number o Phone number where they can be reached Work with Contamination Screening Staff to identify highly contaminated people As necessary, escort people to the appropriate station Direct people as follows: Decision Urgent Medical Need (i.e. any injury or illness requiring immediate medical attention) Highly Contaminated (Review High Contamination Screening Job Aid and screening protocol) Action Escort to First Aid Station Escort to Wash Station 59 OCTOBER 2013

76 / APPENDIX 6 CRC JOB ACTION SHEETS Special Needs (i.e. requires assistance due to decreased mobility or cognitive functioning OR requires translation services or adult supervision) Prior Decontamination (i.e showered at home or was decontaminated near the scene) Arrange Assistance or Escort through CRC Direct to Contamination Screening Express Line (if available) After Shift Report to the Contamination Screening Station to begin demobilization o Contamination Screening Staff will: 1. Direct you on how to remove your PPE 2. Screen you for contamination After entering the Clean Zone: 1. Turn in your dosimetry devices and radiation detection instruments at the Sign-Out Area. 2. Attend the post-shift briefing 60 OCTOBER 2013

77 / APPENDIX 6 CRC JOB ACTION SHEETS First Aid Station Job Action Sheet This station is in the Contamination Control Zone. Workers must wear PPE assigned to them. Before Shift Report to the Staff Sign-In Area Collect assigned PPE and dosimetry devices Attend pre-shift briefing Report to First Aid Station Manager to receive and review your position assignment Inventory First Aid supplies and conduct radio/phone check During Shift Report any emergencies or injuries to your station manager IMMEDIATELY Wear assigned PPE and dosimetry devices Assess patients with urgent medical needs o Examples of urgent medical needs include: Life-threatening conditions (i.e. cardiac arrest, heat stroke, severe dehydration) Open wounds (even minor wounds) can increase the risk of internal contamination Symptoms of acute radiation syndrome (specifically nausea, vomiting, diarrhea) Maintain patient log; including time in, time out, chief complaint, and disposition As possible, avoid physical contact with arrivals to limit cross-contamination o If you touch someone, change your gloves or have them checked for contamination Treat patients in need of immediate medical care o Treatment of life or limb-threatening injuries takes precedence over decontamination o For contaminated patients, perform a gross decontamination by carefully removing outer layer of clothing o Patients with contaminated wounds should be sent to a hospital or alternate care site to have the wound decontaminated and treated As necessary, escort people to the appropriate station 61 OCTOBER 2013

78 / APPENDIX 6 CRC JOB ACTION SHEETS Decision Immediate Medical Transport Necessary (i.e. any injury or illness exceeding the scope of treatment at First Aid) Contaminated Not Contaminated Action Arrange Transport to Hospital or Alternate Care Site (Call or radio for ambulance) Escort to Wash Station (Address medical needs before decontamination) Escort to Registration (After addressing medical needs) After Shift Report to the Contamination Screening Station to begin demobilization o Contamination Screening Staff will: 1. Direct you on how to remove your PPE 2. Screen you for contamination After entering the Clean Zone: 1. Turn in your dosimetry devices at the Sign-Out Area. 2. Attend the post-shift briefing 62 OCTOBER 2013

79 / APPENDIX 6 CRC JOB ACTION SHEETS Contamination Screening Station Job Action Sheet This station is in the Contamination Control Zone. Workers must wear PPE assigned to them. Before Shift Report to the Staff Sign-In Area Collect assigned PPE, dosimetry devices, and radiation detection instruments Attend pre-shift briefing Report to the Contamination Screening Station Manager to receive and review your station assignment o After receiving your station assignment, review the appropriate Job Aid Station Assignment Initial Sorting Contamination Screening Wash Station Screening Assignment Job Aid High Contamination Screening G-M Detector Job Aid Portal Monitor Job Aid G-M Detector Job Aid Portal Monitor Job Aid During Shift Report any emergencies or injuries to your station manager IMMEDIATELY Wear assigned PPE and dosimetry devices As possible, avoid physical contact with arrivals to limit cross-contamination o If you touch someone, change your gloves or have them checked for contamination Screen people for external contamination o Follow screening protocol established by Contamination Screening Station Manager As necessary, escort people to the appropriate station Direct people as follows: Decision Contaminated Action Escort to Wash Station Not Contaminated Direct to Registration 63 OCTOBER 2013

80 / APPENDIX 6 CRC JOB ACTION SHEETS Conduct contamination screenings for workers (including other Contamination Screening Staff) 1. Direct them on how to remove their PPE 2. Screen them for contamination After Shift Report to the Contamination Screening Station to begin demobilization o Contamination Screening Staff will: 1. Direct you on how to remove your PPE 2. Screen you for contamination After entering the Clean Zone: 1. Turn in your dosimetry devices and radiation detection instruments at the Sign-Out Area. 2. Attend the post-shift briefing 64 OCTOBER 2013

81 / APPENDIX 6 CRC JOB ACTION SHEETS Wash Station Job Action Sheet This station is in the Contamination Control Zone. Workers must wear PPE assigned to them. Before Shift Report to the Staff Sign-In Area Collect assigned PPE and dosimetry devices Attend pre-shift briefing Report to the Wash Station Manager to receive and review your position assignment Review Decontamination Job Aid During Shift Report any emergencies or injuries to your station manager IMMEDIATELY Wear assigned PPE and dosimetry devices As possible, avoid physical contact with arrivals to limit cross-contamination o If you touch someone, change your gloves or have them checked for contamination Facilitate showering o Provide verbal directions o Provide shower supplies (e.g. shampoo, soap, towels, and clean clothing) Collect contaminated clothing and personal belongings o Have each person place clothing in a large plastic bag before showering Label clothing bag with person s name and ID number o Have each person place personal belongings (e.g. wallets, keys, jewelry, glasses) in a plastic bag before showering Label personal belongings with the person s name and ID number Check items for contamination, decontaminate them (if necessary), and return them to the owner after they are cleared to enter the Clean Zone Work with Contamination Screening Staff to perform post-decontamination screenings o Wash Station Staff will record and file the results of the contamination screening As necessary, escort people to the appropriate station 65 OCTOBER 2013

82 / APPENDIX 6 CRC JOB ACTION SHEETS During Shift (Continued) Direct people as follows: Decision Shower Not Necessary (i.e. contamination can be removed by washing hands or removing clothing) Shower Necessary (i.e. contamination in hair, on skin, or over large portion of the body) Still Contaminated After First Shower Action Direct to Partial-Body Cleaning Direct to Showers Shower Again Still Contaminated After Second Shower Clean (after partial-body cleaning, first shower, or second shower) Provide Clothing and Escort to Registration (person may be internally contaminated) Provide Clothing and Direct to Registration After Shift Report to the Contamination Screening Station to begin demobilization o Contamination Screening Staff will: 1. Direct you on how to remove your PPE 2. Screen you for contamination After entering the Clean Zone: 1. Turn in your dosimetry devices and radiation detection instruments at the Sign-Out Area. 2. Attend the post-shift briefing 66 OCTOBER 2013

83 / APPENDIX 6 CRC JOB ACTION SHEETS Registration Station Job Action Sheet This station is in the Clean Zone. Workers may still be assigned PPE. Before Shift Report to the Staff Sign-In Area Collect assigned PPE and dosimetry devices Attend pre-shift briefing Report to Registration Manager to receive and review position assignment Review CRC Processing Forms, paying close attention to Form III: Preliminary Exposure Assessment, Radiation Dose Assessment Referral During Shift Report any emergencies or injuries to your station manager IMMEDIATELY Wear assigned PPE and dosimetry devices Interview people as they arrive at Registration o Some people will need immediate medical follow-up at the Radiation Dose Assessment Station o You will identify people who fall into this category based upon: Their responses to the interview questions The results of contamination screenings As necessary, escort people to the appropriate station Direct people as follows: Decision Immediate Follow-Up Necessary (Review Medical Prioritization Job Aid and contamination screening results) Action Escort to Radiation Dose Assessment Station Does Not Need Immediate Follow-Up Direct to Discharge Station After Shift Report to the Contamination Screening Station to begin demobilization o Contamination Screening Staff will screen you for contamination Turn in your dosimetry devices at the Sign-Out Area. Attend the post-shift briefing 67 OCTOBER 2013

84 / APPENDIX 6 CRC JOB ACTION SHEETS Radiation Dose Assessment Station Job Action Sheet This station is in the Clean Zone. Workers may still be assigned PPE. Before Shift Report to the Staff Sign-In Area Collect assigned PPE, dosimetry devices, and radiation detection instruments Attend pre-shift briefing Report to the Radiation Dose Assessment Station Manager to receive and review your position assignment o After receiving your station assignment, review the appropriate Job Aid Station Assignment Internal Contamination Screening Bioassay Collection Medical Evaluation Screening Assignment Job Aid Internal Contamination Screening Job Aid Specimen Collection Job Aid Specimen Shipment Job Aid Acute Radiation Syndrome: A Fact Sheet for Physicians Prenatal Radiation Exposure: A Fact Sheet for Physicians Cutaneous Radiation Injury: A Fact Sheet for Physicians During Shift Report any emergencies or injuries to your station manager IMMEDIATELY Wear assigned PPE and dosimetry devices After Shift Report to the Contamination Screening Station to begin demobilization o Contamination Screening Staff will screen you for contamination Turn in your dosimetry devices at the Sign-Out Area. Attend the post-shift briefing 68 OCTOBER 2013

85 / APPENDIX 6 CRC JOB ACTION SHEETS Discharge Station Job Action Sheet This station is in the Clean Zone. Workers may still be assigned PPE. Before Shift Report to the Staff Sign-In Area Collect assigned PPE and dosimetry devices Attend pre-shift briefing Report to the Discharge Manager to receive and review your position assignment During Shift Report any emergencies or injuries to your station manager IMMEDIATELY Wear PPE and dosimetry devices Assist MH professionals in providing assessments or referrals for people in need of psychological care Provide information and educational material to people leaving the CRC Help people register for a space in a public shelter As necessary, escort people out of the CRC Assist people as follows: Decision Person Requires Referral for Further Care (i.e. additional medical consultation or counseling) Person Does Not Need Further Care Action Provide Referral Discharge to Home or Shelter After Shift Report to the Contamination Screening Station to begin demobilization o Contamination Screening Staff will screen you for contamination Turn in your dosimetry devices at the Sign-Out Area. Attend the post-shift briefing 69 OCTOBER 2013

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87 / APPENDIX 6 CRC JOB ACTION SHEETS CONTAMINATION ASSESSMENT FORM NAME: _ (LAST) (FIRST) (MI) ID NUMBER: DATE: TIME: HAS THE PERSON RECENTLY HAD A STRESS TEST, CHEMOTHERAPY, BRACHYTHERAPY, PET SCAN, THYROID ABLATION OR OTHER NUCLEAR MEDICINE PROCEDURE? YES NO IF YES, CONTAMINATION SCREENING RESULTS MAY BE ELEVATED. SCREENING CRITERIA: CPM CPM INSTRUCTIONS: BACKGROUND: RECORD MEASURED LEVELS OF CONTAMINATION FOR SPECIFIED AREAS MARK CONTAMINATION FINDINGS ON DIAGRAMS IDENTIFY CONTAMINATED WOUNDS IF PRESENT PLACE AN X IN THE BOX IF NO MEASUREMENTS WERE TAKEN TABLE 1: PRE-DECONTAMINATION MEASUREMENTS (IN CPM) HEAD BREATHING ZONE TORSO ARM HAND LEG SOLE OF SHOE FRONT LEFT BACK RIGHT 71 OCTOBER 2013

88 / APPENDIX 6 CRC JOB ACTION SHEETS TABLE 2: POST-DECONTAMINATION MEASUREMENTS (IN CPM) HEAD BREATHING ZONE TORSO FRONT BACK LEFT RIGHT ARM HAND LEG SOLE OF SHOE 72 OCTOBER 2013