Initial On-site Activities During a Radiation Emergency

• Manage the Scene
• Manage the Victims: Triage, Treat, Transport

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Manage the Scene

• Notify appropriate authorities
• Control incident perimeter
• Establish Incident Command
• Identify radiation types and isotopes
• Measure levels of radiation continuously
• Ensure responder safety
  • Wear personal protective equipment (PPE)
  • Use personal dosimeters
  • Consult radiation worker exposure guides
• Establish "zones of response"
  • Radiological incident zones of response
  • IND incident zones of response
• Initial actions for EMS staff after Nuclear Detonation
  • First Responders: Emergency Medical Service Staff: 2 page summary sheet (US Government Interagency, May 2014, Version 1.0, Draft for Interim Use) (PDF - 1.02 MB)
• Establish patient handling flows
  • In the field
    • Establish locations for field activities (IAEA)
    • Patient handling flows in the field for a radiological event (IAEA)
    • Flow chart example of community reception center with potentially contaminated victims (PDF - 2.68 MB) (REAC/TS)
    • RTR system (Triage, treatment and transport after an IND detonation)
    • At the scene on an incident with radionuclide release (NCRP Report No. 161, Part 1, page 77 and 90, December 2008)
  • In a medical facility
    • Prototype for zones to handle staff/patients in medical facility at mass casualty incident (HPS)

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Manage the Victims: Triage, Treat, Transport

• Perform lifesaving activities before managing radiation problems
• Perform triage using protocols appropriate to event type and number of victims
  • Trauma triage in small events
  • Radiation triage in small events
  • Triage after an IND detonation
  • Triage after an IND detonation (Interactive tool)
    • Triage victims with trauma, burns, and/or radiation exposure
    • Suggested for use when resources are scarce initially
• Communicate with medical facilities that will receive patients
  • Identify approximate number, type, severity of casualties
• Transport patients to appropriate facilities
  • Transport of victims in a radiation incident
    • Contaminated patients
    • Exposed patients
    • Emergency Response to a Transportation Accident Involving Radioactive Material (YouTube - 18:18 minutes) (DOE/TEPP/MERRTT and DHS/FEMA)
      • Video User's Guide (PDF - 547 KB)
    • Pre-Hospital Practices for Handling a Radiologically Contaminated Patient (YouTube - 12:00 minutes) (DOE/TEPP/MERRTT and DHS/FEMA)
      • Video User's Guide (PDF - 696 KB)
  • Use "Response Category System" to match victim exposure severity with appropriate venue
  • Consult RTR system (Triage, Treat, Transport) for global view of where patients will go
  • Consider referral to center with radiation injury expertise (e.g. Radiation Injury Treatment Network)
• Incident managers will protect the public and responders from future radiation exposure by implementing
  • Protective Actions
  • Protective Action Guides
  • Worker Exposure Guidelines
  • Regular communications to the public with up-to-date incident information

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