: 828-1392
Office of Environmental Health & Safety
Chemical/Biological Safety Section
Hazardous Materials Emergency Plan
TABLE OF CONTENTS
I. Description
II. Objectives
III. Definitions
IV. Hazardous Materials Emergency Response
A. Introduction
B. Notification
D. Primary Staff: Job Descriptions
F. MCVH - EMS Policy and Procedures
V. Appendix A - Disaster Plan Medical Control Worksheet
VI. Appendix B -
Doctor Green Alert List
| I. DESCRIPTION |
Virginia Commonwealth University (VCU)
and the Medical College of Virginia Hospitals (MCVH) recognizes the distinctive
nature of patient management for individuals who have been exposed to injurious
chemical substances. This plan combines the resources of the Office
of Environmental Health & Safety (OEHS), and the MCVH Department
of Emergency Services, to provide an effective
medical response to chemical emergencies.
| II. OBJECTIVES |
A. To treat and assist patients who have received chemical exposure utilizing the best available medical practices, ensuring that life saving actions take priority over contamination control.
B. To avoid and/or minimize chemical exposure to hospital personnel, patients, and property.
C. To train MCVH/VCU personnel regarding the procedures
for managing hazardous materials emergencies.
| III. DEFINITIONS |
controlled area - That area controlled by the Hazardous Materials Team (HMT) in order to restrict the spread of contamination within Emergency Services or Sanger Hall. It shall include, but not be limited to the Radiation/HazMat facilities in the Episodic Care Center (ECC) of the emergency room (ER), and/or the morgue, shower rooms B2-058 and B2-060, the immediate loading dock area of Sanger Hall.
carcinogen - A substance capable of causing cancer.
chemical agents - A wide variety of substances that may cause injury to the body either through direct contact, inhalation, ingestion, injection, or entry through an open wound. Some are more toxic than others and require special measures of control for safety and environmental reasons.
combustible - Able to catch on fire and burn.
decontamination - The process of removing chemical substances from the external surfaces of a person, object, etc.
flammable - Capable of being easily ignited and of burning with extreme rapidity.
infectious agents - Sources that cause biological infections either by inhalation, ingestion, or direct contact with the host material.
LC-50 - The concentration of a substance in air that causes death in 50% of the animals exposed by inhalation. A measure of acute toxicity.
LD-50 - The dose that causes death in 50% of the animals exposed by swallowing a substance. A measure of acute toxicity. Commonly, the route of entry is specified (i.e., oral, inhalation, etc..)
material safety data sheets (MSDSs) - A chemical information sheet providing guidance for safely handling specific chemicals and mixtures of chemicals.
monitoring equipment - Any equipment used for the immediate detection of chemical. (Example: Draeger colorimetric tubes)
mutagen - Capable of changing cells in such a way that future cell generations are affected. Mutagenic substances are usually considered suspect carcinogens.
pH - A measure of how acetic or caustic a substance is on a scale of 1 to 14. A pH of 1 indicates that a substance is acetic; and a pH of 14 indicates that a substance is basic.
sensitizer - An agent to which repeated exposure over time may create an allergic reaction at some point in time.
TLV - Threshold Limit Value. The amount of exposure allowable for an employee in an 8-hour day.
TOMES Index - A computerized
data base, maintained by the VPC, which provides updated information for
managing patients exposed to specific chemicals. The index is also available
through the VCU Library on-line references.
| IV. HAZARDOUS MATERIALS EMERGENCY RESPONSE |
A hazardous materials emergency may be defined as an unforeseen occurrence, such as a spill, which contaminates individuals involved in the occurrence or individuals in the area of the occurrence. The MCVH/VCU Hazardous Materials Emergency Plan is designed to manage victims of chemical emergencies occurring in the Greater Richmond Metropolitan Area.
In the event of a major chemical spill involving human exposure, the local fire department's hazardous materials (HazMat) team should be mobilized to treat victims and remediate the spill. The HazMat team may decontaminate victims to some extent.
Victims will be brought to a triage area outside the entrance to the decontamination rooms in the ECC. If it is possible, all victims will be decontaminated and treated in the ECC. The ECC is equipped to treat as many as four (4) severely contaminated patients at one time. If there are more victims than can be handled at one time in the ECC, the morgue/autopsy area located in Sanger Hall may be utilized for patients with minor injury. When an overflow of victims required the use of the Sanger Hall morgue/autopsy area, a "Dr. Green" hazardous materials emergency alert is called.
Additional patients may be treated depending upon the degree of emergency medical care needed and degree of contamination. The morgue/autopsy area in Sanger Hall can accommodate up to six additional patients at one time.
In some cases, the community disaster plan may need to be initiated in order to deal with an excessive number of victims.
Depending on the circumstances of the chemically-related accident, notification to MCVH/VCU may originate from various sources. The initial call may be to the OEHS emergency telephone number (828-9834), MCVH Emergency Services (828-8888), or to the Patient Representative (828-0958). Refer to flow chart (Appendix D) for notification scheme.
To initiate the Hazardous Material Emergency Plan, the OEHS Chemical/Biological Safety staff, the Trauma ER charge nurse in Emergency Services, and the Patient Representative must all be informed of the emergency as soon as possible. Prompt communication among these areas is crucial for the plan to work as designed.
1. Emergency Services: Any Emergency Services employee receiving notification of the impending arrival of patients potentially contaminated with hazardous materials should notify the Trauma Emergency Room (ER) Charge Nurse and the senior resident in the appropriate area. The Trauma ER Charge Nurse (or designee) will notify the OEHS Chemical/Biological Safety staff, the Administrator of Emergency Services (in the absence of the Administrator of Emergency Services the Trauma ER Charge Nurse will notify the Patient Representative), the attending physician in the appropriate area, the Clinician B (or designee) on duty, and the Registration Supervisor. The Administrator of Emergency Services (or designee) will notify the VCU police to secure the arrival site and to arrange transportation from "I" lot if helicopter services are to be utilized.
2. OEHS: The OEHS emergency telephone line is available 24 hours for emergency calls. After working hours, emergency line calls are automatically transferred to MCVH Telepage. In this case, telepage operators will contact the Chemical/Biological Safety staff members on call. Any staff member being notified directly of the impending arrival of contaminated victims will notify the Trauma ER Charge Nurse and the Patient Representative.
3. The person receiving the initial call will take the name and location of the caller and also obtain the necessary information about the accident. All information will be recorded on the "Disaster Plan Medical Control Worksheet" (Appendix A). The following information about the incident and victim should be obtained:
a. name and phone number of individual calling
b. an accurate spelling of the chemical(s) involved
c. number of victims
d. severity of injuries and status of victims
e. if there is airborne contamination
f. time that the accident occurred
g. estimated time of arrival (ETA)
h. contact person for additional information
4. "Dr. Green" Alert: Based on the number of victims, the Chemical Safety Director and the Medical Director will decide whether it will be necessary to utilize the Sanger Hall morgue location. If this area will be used for decontamination and treatment of victims, a "Dr. Green" alert will be called.
a. If a "Dr. Green" alert is called, verify that the call is genuine by confirming it with the caller.
b. Instruct Telepage (828-0951) to make the "Dr. Green" announcement (warning sound; "Dr. Green", "Dr. Green", B-2 Sanger Hall; repeat) and to start contacting members on the alert list (see Appendix B).
c. Alert the MCVH/VCU police to the situation.
d. Contact the Patient Representative to arrange for transportation from "I" parking lot to MCVH if helicopter services are to be utilized.
1. Patient Representative: Upon receiving notification of a hazardous materials accident, the Patient Representative is responsible for alerting the appropriate individuals, including the Chemical Safety Director or senior Chemical/Biological Safety staff member.
2. University Press Officer: The University Press Officer is responsible for the handling of all information released to the news media. The University Press Officer may be called upon by the Chemical Safety Director to prevent unauthorized members of the press from entering the controlled area. All news releases will be cleared with the University Press Officer.
3. Housekeeping Staff: For a Sanger Hall response, the Housekeeping Staff located on the B-2 level of Sanger Hall are responsible for removing all vehicles from the loading dock area and closing off and securing their area adjacent to the morgue.
4. Transportation to MCVH: If helicopter service is used, the helicopter should be routed to the emergency landing area in "I" parking lot. Emergency vehicle transportation will be waiting. The emergency department at MCVH currently has two systems for radio communication with incoming ambulances:
a. HEAR (Hospital Emergency and Administrative Radio) System: operating on 155.340 MHZ.
b. COR (Coronary Observation Radio) System: current frequencies are MED 1, MED 4, MED 5, MED 8.
5. VCU Police: The VCU Police provide assistance by securing decontamination areas; assisting transportation of victims once on campus; and, assisting in radio telecommunications.
D. Primary Staff: Job Descriptions
1. Chemical Safety Director: The Chemical Safety Director, along with the Medical Director, is responsible for coordinating all hazardous materials emergency activities within MCVH/VCU. The Chemical Safety Director has unrestricted authority in deciding what measures should be taken regarding personnel within the controlled area. The Chemical Safety Director and the Medical Director will evaluate all patient needs.
The Chemical Safety Director:
a. Is responsible for alerting those members of the Hazardous Materials Team considered necessary. (See Alert List - Appendix B)
b. In conjunction with the Medical Director, will evaluate the arriving casualties and decide how to prioritize and where to route each victim. If there are more victims than the ECC can handle, the Sanger Hall morgue area will be used.
2. Chemical/Biological Safety Staff: The following are responsibilities of the OEHS Chemical/Biological safety staff.
a. Evaluate Casualties: The necessity for, type and extent of decontamination of chemically contaminated patients.
b. Protect Medical Staff: Ensure that medical staff have properly donned the appropriate personal protective clothing/equipment.
At a minimum, all persons in the controlled areas or working with chemically contaminated patients will wear:
1) Tyvek® Coveralls w/head & feet covering
2) two pair surgical gloves
3) N95 respirator (TB/Bloodborne pathogen mask)
4) eye protection, as warranted
Additionally, if a significant potential exists for air-borne contamination of organic vapors or acid vapors, the following additional protective equipment must be worn:
1) Organic vapor/acid gas respirator
2) Appropriate chemically resistant glove
3. Medical Director: The Medical Director is in charge of all medical aspects of the emergency plan. The Medical Director works with the Chemical Safety Director to evaluate the needs and insure the safety of all patients and personnel within the controlled area.
4. Medical Staff
a. The staff located in both the ECC and the Sanger Hall morgue area shall be capable of providing all necessary medical services, including emergency surgery. The number of doctors and nurses assigned will be decided by the Medical Director. The Trauma ER Charge Nurse will coordinate notification of the Emergency Services medical staff and the Chemical Safety Director.
b. In the Sanger Hall morgue area, the Medical Director will appoint the appropriate individuals to provide general first aid and/or any pre-operational medical care.
c. The Medical Director and designated supportive staff will be located in the triage area to evaluate all incoming cases.
d. Paramedical personnel able to assist in the transfer of patients from incoming vehicles will be located in the triage area of the ECC and, if needed, on the loading dock of Sanger Hall.
5. VCU Police: The VCU police will be called upon to prevent unnecessary vehicles from entering the area and to keep unauthorized personnel away from the controlled area doorways.
a. Outside the ECC, one officer will secure the area where the emergency vehicle will arrive.
b. A second officer will be stationed at the 12th street entrance to the emergency room driveway to direct incoming vehicles and to prevent unauthorized individuals from entering the controlled area. After the victim is transported inside the hospital, the officer stationed at the entrance to the driveway will enter the Hospital and secure the controlled area there.
When Sanger Hall is utilized:
c. One police officer will be located at the Marshall Street entrance to the Sanger Hall loading dock to direct incoming vehicles. Only authorized vehicles will be allowed to enter the loading dock.
d. One police officer will be located on the loading dock to direct incoming vehicles and aid in the control of unauthorized individuals.
e. One police officer will be located at the east end of the hallway outside the controlled area to insure that only authorized individuals enter.
f. One police officer shall insure that the elevators that open into the controlled area are locked on the B-2 level of Sanger Hall and that no one uses them.
g. Additional police officers responding shall be utilized for controlling and routing traffic outside of Sanger Hall and the receiving area.
6. Hospital Transportation: When the Sanger Hall morgue area is utilized, the Hospital Transportation Department will be notified to provide four (4) stretchers and three (3) persons to wait in the corridor outside of OEHS. These individuals will be responsible for transporting patients from the controlled area to the ECC.
7. Central Service: When the Sanger Hall/morgue area is utilized, Central Service is responsible for bringing two (2) life packs, each including one (1) defibrillator and one (1) heart monitor, one (1) adult code blue cart, and two (2) portable oxygen set-ups with standsto the corridor outside the morgue area.
8. Pharmacy: When the Sanger Hall morgue area is utilized, the Pharmacy Department will provide one (1) Medical Emergency Disaster Kit and will deliver the kit to that area.
The
HEAR (Hospital Emergency and Administrative Radio) system, operating on
155.340 MHZ, is available for relaying vital medical information from the
ambulance rescue team to MCVH Emergency Services. Emergency Services can
then dispatch this information to the Medical Director for further evaluation,
or can phone-link the Medical Director to the transportation vehicle.
| SUBJECT:
CARE OF PERSONS HAZARDOUS MATERIALS EXPOSEDTO HAZARDOUS/RADIOACTIVE MATERIAL |
File Section: H |
| Original Date: 12/90 | |
| Review Date: 12/95 | |
| Effective Date: 1/96 |
The Emergency Room staff shall follow a described plan to safeguard patients and staff when a patient has been or is suspected to have been exposed to hazardous substances or radioactive materials.
PROCEDURES
1. The Triage Nurse or any ER employee receiving notification of the impending arrival of a patient contaminated with a potentially hazardous or radioactive material should immediately notify the Trauma ER Charge Nurse and the senior resident in the appropriate ER.
2. The following information, at minimum, should be obtained from the informant:
a. Is this a radiation or a chemical exposure?
b. What is the substance? Obtain specific information including the placard number displayed on the vehicle, if applicable.
c. What is the mechanism of exposure? (ex: inhalation, skin contamination, ingestion)?
d. Is there a known airborne hazard?
e. Number of victims?
f. Status of the victims; what injuries have been identified?
g. What type of treatment has been rendered in the field?
h. ETA?
i. Contact person and call back phone number for additional information.
For a radiation emergency only, also obtain the following information, if known:
j. Location, amount, and source of contamination in cpm or dpm.
k. If there are neutron irradiated victims.
l. Estimated dose received by victim(s).
3. The following notification will be made by the Trauma ER Charge Nurse or her designee:
a. Notify the Office of Environmental Health and Safety via Telepage. State specifically whether the emergency is a chemical or a radiation emergency. Instruct the operator as follows: "Please contact an individual on the CHEMICAL EMERGENCY LIST(OR RADIATION EMERGENCY LIST) to call the ER regarding a chemical (or radiation) emergency". If no response is obtained via telepage within 5-10 minutes, contact the OEHS staff directly via the long-range beeper system.
b. Relay information to the following individuals:
(1). Director of Emergency Services
(2). Patient Representative.
(3). Attending physician in the appropriate ER.
(4). Registered Nurse Manager of Medical/Surgical ER or Registered Nurse Manager on-call.
(5). ER Registration Supervisor.
(6). ER Radiology - to have a radiologic technologist available to perform mobile x-ray examinations if needed.
4. The Patient Representative will notify VCU Police to secure the arrival site, if indicated.
5. If the emergency involves a chemical exposure, the Trauma charge nurse should obtain relevant information from the Poison Center.
6. After the Radiation Safety (or Hazardous Materials) and Medical teams report to the Episodic Care Center (and the Sanger Hall morgue area, if needed), the Radiation (or Chemical) Safety Director and the Medical director will assign job tasks for the team.
7. The decontamination areas will be prepared and individuals who are assigned to the controlled areas will dress in protective clothing and will wear dosimeters as directed by the Radiation (or Chemical) Safety Director.
8. Incoming patient flow will be as follows: Victims are received in the triage area in the Emergency Services drive. The victim(s) will be assessed in the ambulance by the Medical Director and the Radiation (or Chemical) Safety Director. Based on the medical and radiological/chemical evaluations, the victims will be decontaminated and treated in either ECC, or transported to the Sanger Hall morgue area. In the morgue area the victims will be decontaminated and medically treated, or stabilized and then transported back to Emergency Services to be admitted or released. EMERGENCY LIFESAVING MEASURES ARE TO ALWAYS TAKE PRECEDENCE OVER DECONTAMINATION ACTIVITIES.
9. Instruct pre-hospital care providers to remain with their vehicles until they and their vehicles can be thoroughly surveyed, decontaminated, and released for duty by the OEHS.
10. Transport the injured victims(s) to the designated, prepared rooms in the Episodic Care Clinic (EEC) via the doorway that connects the ambulance entrance to the Episodic Care Clinic. Place the victim(s) on decontamination tubs that have been strapped to the stretchers.
11. Rooms G-211, 212, 213, 214 in the Episodic Care Clinic will be used for all patients seen in the ER unless the number of patients requiring medical care and decontamination exceeds the space available in the designated rooms. In such an event, the Trauma ER Charge Nurse, in consultation with the OEHS staff and Medical Director, will determine the placement of patients.
12. Unstable, contaminated patients will be managed in the decontamination area. Necessary monitoring equipment and any other life-support equipment will be transported to the decontamination area. The Radiation (or Chemical) Safety Director, in consultation with the Medical Director, will make the final decision regarding relocation of the patient(s) from the decontamination area.
Preparation of Decontamination Area
All members of the Radiation (or Hazardous Materials) Safety team notified to assist in the handling of the emergency will assemble in MCVH Emergency Services. The Radiation (or Chemical) Safety Director (or team leader) will assign specific positions and responsibilities to each person. (See Emergency Team and Areas of Responsibility).
The emergency cabinets in the treatment and decontamination rooms in the ECC will be opened and the appropriate protective clothing and equipment will be distributed. The responding personnel will be matched to the job descriptions according to their medical and/or radiological/hazardous materials specialties.
To prepare area:
1. Cut on the exhaust fans.
2. Personnel preparation:
a. Put on Tyvek jumpsuit and head cover.
b. Put on shoe covers and tape to legs of jumpsuit.
c. Put on one pair of surgical gloves and tape to sleeves of jumpsuit. Put on a second pair, untapped so that outer gloves can be changed when necessary.
d. Put on surgical mask. (Wear respirators if there is airborne radioactivity or chemicals.)
e. Assign and wear pocket dosimeters (radiation emergencies only).
f. Place a strip of masking tape on each person designating their job duties, such as R.N. for nurses, M.D. for physicians, Radiation (or Chemical) Safety Director, Radiation Safety staff, etc.
3. Prepare the area using the following materials from cabinets in the Episodic Care Center. The nurse(s) assigned should assemble medical supplies such as gauze, scissors, saline, etc. in each decontamination room.
a. Rope to cordon off the area.
b. Decontamination tub--buckle underneath stretcher.
c. Hose and carboys.
d. Clipboard and paper to record events.
e. Absorbent paper, Terri wipes, sheets.
f. Large plastic bags for contaminated trash--place on linen stand and tag as radioactive or hazardous waste. Place one in the decontamination room and one bag in the hallway where personnel will leave the controlled area.
g. Large plastic bag for victim's clothing and articles--tag if contaminated.
For a radiation emergency only.
h. Herculite mats for hallway, decontamination rooms, and emergency vehicle receiving areas.
i. Self-reading dosimeters.
j. Radiation signs with rope.
k. Sample taking kit(s).
l. Geiger counters and survey meters, with plastic bag over probes. Check background in an uncontaminated area and document.
m. Tape to cover light switches and door knobs.
n. "Caution-Radioactive Materials" sign for the outside door to the ECC area.
o. Lead pigs for contaminated specimens.
Radiation Exposure Control and Dose Limits
1. General Population: Up to 5 rem
2. Emergency Workers:
a. Under 18 years: 0.5 rem
b. Declared pregnant females: 0.5 rem
c. Turn back level: 5 rem
d. Lifesaving activities: 25 rem per event
3. Self-reading dosimeters should be read every 30 minutes at a minimum, and the supervisor notified at 3 rem so that a replacement worker can be found. At 3 rem, the radiological officer will determine if the limit should be extended to 25 rem. This may be done once per event for a lifesaving mission or for the protection of the larger population. The risks must be explained to the emergency worker and the worker's acceptance of the extension is voluntary.
Decontamination of Patients
1. When an ambulance arrives at Emergency Services, the victims will be assessed by both the Medical Director and the Radiation (or Chemical) Safety Director.
2. Transport the patient(s) on the decontamination tub that has been strapped to a stretcher to the designated rooms in the ECC (G-211, 212, 213, and 214) via the doorway to the ECC entrance
3. After stabilization and emergency medical treatment of the patient is achieved, initiate decontamination procedures as follows:
a. If the patient's clothes are contaminated, remove and place them in a plastic bag, and label them with the patient's name and a tag stating "Radioactive - DO NOT DISCARD" or "Hazardous Materials - DO NOT DISCARD". The Radiation (or Hazardous Materials) Safety team will be responsible for decontamination activities associated with the patient's belongings.
b. If requested by the Radiation Safety Director, skin wipes and evaluation of internal contamination will be done, i.e., cotton swab samples of ear canals, nostrils and mouth. These swabs will be placed in separate containers labeled with the patient's name, date and site of the sample (radiation emergencies only).
c. Radiation contamination monitoring is performed by covering the probe with a plastic bag. Hold the probe about inch from the item or person and move the probe about 1 inches per second. Monitor the entire body, front and back, to determine the area and extent of contamination. Record the radiation exposure values and radioactive contamination levels at known distances and sites. Decontamination is to be done in the following priority:
1. Contaminated open wounds
2. Contaminated eyes
3. Contaminated nostrils or mouth
4. Contaminated ear canals
5. Contaminated intact skin
6. Contaminated hair
If a hot particle or "flea" is found, it should be isolated and removed to a shielded container. A piece of tape, with the sticky side out, can be useful in securing a hot particle.
If radioactivity is distributed throughout the body and hair, it may be due to neutron activation. In this case a sample of hair will be taken for further analysis and a quick estimate of whole body neutron exposure will be made as follows:
Place a GM tube against the abdomen with the person bent over or, if this is not practical, under the armpit (keep away from local contamination). The neutron dose received can then be estimated (from the 24Na produced) using the following calculations:
If surveyed at two (2) hours after accident
Dose (rads) = 8,000 x mR/hr
Body wt.(lbs.)
If surveyed at fifteen (15) hours after accident
Dose (rads) = 16,000 x mR/hr
Body wt. (lbs.)
If after decontamination the exposure level at one meter is less than 20 mR/hr, the patient may be released to hospital areas (with the proper warning labels).
d. Open Wounds: The first priority in the decontamination procedure should be contaminated open wounds because these areas allow for rapid incorporation of radionuclides or hazardous materials. Decorporation procedures should be started and irrigation of the wound should begin with copious amounts of normal saline for at least three minutes and repeated as needed. If monitoring shows persistent radioactive contamination, wash with 3% hydrogen peroxide. If repeated monitoring shows that contamination persists, gentle surgical debridement of the surface tissue of the wound should be done. It need not be radical, as most of the contamination will adhere to the outer surface of the wound. Deep debridement and excision should be necessary only when particles or pieces of radioactive material have been imploded into the tissues. Any tissue removed should be placed in a tube and then placed in a lead container for later analysis.
e. Eyes, Nose, and Ears: If radioactive or hazardous material is found in the eyes, gentle irrigation should be undertaken with the stream diverted away from the medial canthus so that it does not force material into the lacrimal duct. Contaminated nose and ear canals should be gently irrigated with frequent suction so that radioactive and hazardous material is not forced deeper into those cavities. It is very important to take immediate action if radioactive or hazardous material is found in the oral cavity, because if it reaches the stomach, internal contamination and incorporation will occur. Gentle irrigation and suction should be started promptly with the mouth turned sideways or down (as the patient's condition allows) so that the irrigation solution runs out of the mouth and is not swallowed. After the mouth has been decontaminated, a nasogastric tube should be inserted into the stomach in order to determine whether radioactive material is present. If so, decorporation should be started, and lavage should be instigated with normal saline in small aliquots (less than 300 cc's) so that the stomach contents are not forced through the pyloric sphincter.
f. Skin: The skin is naturally the most common area of the body to be contaminated. However, gentle scrubbing with soap and tepid water is usually all that is needed to remove the contamination. Hot water should not be used because it causes cutaneous vasodilatation, and this increases the chances of incorporation. For the same reason, a stiff brush should not be used and the area should not be scrubbed too vigorously. If contamination persists after two or three washings, LavaR soap can be used as a gentle abrasive. If contamination persists, use a mixture of TideR and cornmeal. As a last resort use bleach, full strength for small areas, diluted for larger areas. (See Appendix III for more personnel decontamination information.)
g. Hair: Hair can usually be decontaminated with repeated shampooing with soap and tepid water. If contamination persists, the hair can be removed with clippers, but the scalp should not be shaved, for any breaking of the skin will allow incorporation.
4. Continue decontamination procedures as long as efforts continue to be effective in reducing levels of contamination. If skin abrasions occur, the procedures should be discontinued. If specialized medical treatment is required for patients with ingestion or massive exposure of radiation, the physician directly involved in the management of radiation accident victims can request assistance from the Radiation Emergency Assistance Center/Training Site (REAC/TS) in Oak Ridge, Tennessee. REAC/TS provides telephone consultation on a 24-hour basis, or a response team, after consultation with a Radiation Safety staff member, can be dispatched, if necessary. REAC/TS will accept patients, following initial treatment and provide treatment related to their radiation injuries. REAC/TS can be contacted using the 24 hour emergency number:
(615)481-1000 or (615) 576-3131 (ask for REAC Department)
a. Obtain radiation meter readings throughout the decontamination procedure by the Radiation Safety staff and record. Samples of blood, urine, irrigation fluid from wounds, etc. may be ordered by the Radiation Safety Director to assess contamination levels and possible internal dose estimates.
b. Dry the patient's body thoroughly and re-swab all previously contaminated areas with cotton-tipped applicators. Mark as "post-decontamination" specimens and store for later analysis by Radiation Safety.
c. If no contamination is found when the patient is re-monitored, place new floor coverings from the clean line to the stretcher where the patient lies. Bring in a clean stretcher and transfer the patient. Wheel the stretcher and patient to the door. After radiation safety personnel make a final check of the patient and the stretcher (especially the wheels), transport the patient from the area. After the patient has been medically treated and decontaminated, he/she can be discharged or admitted to the hospital, depending on the clinical condition.
d. Personnel not involved with the decontamination procedures should transport the decontaminated patient away from the controlled area.
e. Patients awaiting decontamination should be covered with a sheet and be attended by nursing and medical staff who are wearing appropriate protective clothing.
5. Upon termination of the decontamination efforts, all personnel must adhere to the following dress-out routine. Protective clothing worn by the staff is to be saved for proper disposal under the direction of the Radiation (or Hazardous Material) Safety team. Remove protective clothing as follows (monitoring applies to radiation emergencies only):
a. Remove outer pair of gloves.
b. Remove tape from around ankles and wrists.
c. Remove hood by leaning backward and pulling the hood back away from head.
d. Remove jumpsuit.
e. Remove one shoe cover, monitor the foot and step from controlled area to clean area with uncovered foot. Remove second shoe cover, monitor that foot and step into the clean area.
f. Remove gloves.
g. Monitor with appropriate instruments. Pay particular attention to monitoring the head, shoulders, hands and feet
6. The Radiation (or Hazardous Material) Safety team is responsible for monitoring and decontaminating personnel, the ambulance and attendants, the receiving areas, and controlled areas. The Radiation (or Hazardous Material) Safety team will oversee the disposal of any clothing, linen, refuse, and water found to be contaminated.
7. To clear a vehicle (radiation emergencies only), first monitor for contamination on the inside. Then, on the outside, monitor the front grill and bumper, tires, wheel wells, and air intake filter.
Approved:
__________________________________________________ _____________
Director, Emergency Medical Services
Date
________________________________________________ _____________
Administrator/Director, Emergency Services
Date
| V. Appendix A |
Disaster Plan Medical Control Worksheet
Part 1 - data collection
Date: _____ /_____ / _____ Time call received: __________ : __________
1. Name & Agency of Caller __________________________________________________
2. Call Back Number ________________________________________________________
3. Description of Situation: _____________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
4. Estimated Number of Patients:
# Red Patients ____________________
# Yellow Patients ____________________
# Green Patients ____________________
# Peds Patients ____________________
# Burn Patients ____________________
# HazMat Patients ____________________
# Radiation Patients ____________________
5. Estimated Time to Initiate Transports: ___________________________________________
6. Closest Hospital to Scene ____________________________________________________
7. Name and Number of Contact Person___________________________________________
8. Additional Information ______________________________________________________
___________________________________________________________________________
___________________________________________________________________________
| VI. Appendix B |
DOCTOR GREEN ALERT LIST
| 1. HAZARDOUS MATERIALS TEAM | OFFICE | BEEPER |
| Dean Broga, Ph.D. | 828-6347 | 215-0465 |
| Dave Jones | 827-2202 | 215-1806 |
| Mike Miller | 828-1392 | 215-1882 |
| Mike Elliott | 828-1392 | 215-4843 |
| Brian Cowles | 828-1392 | *60, 6743 |
| 2. MEDICAL TEAM | . |
| Chief Medical Resident, Telepage | 8-0951 |
| Chief Surgical Resident, Telepage | 8-0951 |
| Chief Burn Resident, Telepage | 8-0951 |
| 3. SUPPORT TEAM | OFFICE | HOME | BEEPER |
| Telepage | 828-0951 or 828-0957 | . | . |
| Emergency Medical Control | 828-8888 | . | . |
| Clinical Coordinator | 628-0096 | . | . |
| Hospital Incident Commander | 828-0951 | . | . |
| Nursing Supervisor | 828-0341 | . | . |
| Nursing Administrator | 828-4221 | . | . |
| VCU Police & Security | 828-1234 | . | . |
| D. Welch, L. Watson (VCU Police) | 828-6199 | . | . |
| Pharmacy(Disaster Kit) | 828-0364 | . | . |
| Hospital Transporation | 828-9421 | . | . |
| Central Service | 828-0360 or 828-0361 | . | . |
| Sterile Processing | 828-0327 or 828-0432 | . | . |
| Joseph P. Ornato, MD | 828-7184 | 914-3344(cell) | 1-888-319-8049 |
| Stephanie Gonzalez, MD, Disaster Comm. | 225-4092 | 364-3475 | 3069 |
| David Swanson, Marketing/Public Affairs | 225-4437 | 897-3374 | 6054 |
| Portable X-ray | 828-5498 or 828-3666 or 828-3675 | . | . |
about Hazardous
Materials Emergency Plan, please contact
Mike
Miller.
: 828-1392
| OEHS Home Page | CBSS Home Page | VCU Home Page |