Hospital Staff:
Information for Radiation Emergencies
- Planning guidance documents
- Planning for radiation-specific hospital activities
- Initial actions for emergency department staff after a nuclear detonation
- Radiation issues at hospitals
- Crisis standards of care
- Incident Command System and Hospital Incident Command System
- Clinical management of radiation injury issues
- REMM tools for hospitals
- References
Planning guidance documents
Planning for radiation-specific hospital activities
- Notify authorities: Radiation Emergency Contacts List
- Create a hospital radiation response team
- Create an hospital response plan
- Plan for surge in patient numbers
- Equip the ED for a radiation emergency
- Understand radiation countermeasures
Initial actions for emergency department staff after a nuclear detonation
- First Receivers: Emergency Department Staff: 2 page summary sheet (US Government Interagency, May 2014, Version 1.0, Draft for Interim Use) (PDF - 1 MB)
Radiation issues at hospitals
-
For staff
- Badge by name and function
- Engage radiation safety personnel
- Implement worker exposure guidelines, including those for pregnant workers
-
Assign
radiation survey meters,
PPE and
dosimeters to staff
who need them
- Accessible, in working order, with prior training on how to use
- Implement perimeter security and internal hospital security
-
Minimize and manage hospital contamination if it occurs
- How to identify contamination
- How to perform decontamination
- Where to locate the decontamination facility
- Instruct medical staff and housekeeping about management of contaminated waste
- How to handle radioactive water in runoff
- Implement emergency triage procedures consistent with the radiation hazard
-
Communicate
- With other responders
- With the public
- Engage Public Information Officers
- Fatality management for deceased with contamination and/or exposure
- Training
- Agreements for resources sharing with local/regional authorities should be established in advance
-
Understand potential scarce resource issues
-
Plan for how/when standards of care will change from
"normal" to "contingency" or "crisis"
- Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report, (NAS/IOM, National Academies Press, 2009)
- IOM has provided updated recommendations in 2012.
- AHRQ has also provided guidance about implementation on this topic.
- Manage ARS with Scarce Resources after an IND
- Understand access to the Strategic National Stockpile
-
Plan for how/when standards of care will change from
"normal" to "contingency" or "crisis"
-
For visitors and patients
- Detect contamination at entrance areas
- Develop policy for managing contaminated locations and persons
- Keep track of all who enter including patients and visitors during the event, with wrist banding and database
- Develop policy for long term follow-up
Crisis standards of care
- Crisis Standards of Care: A Toolkit of Indicators and Triggers (Institute of Medicine, July 31, 2013)
-
Crisis Standards of Care (CSC): A Systems Framework for
Catastrophic Disaster Response
(Institute of Medicine, March 21, 2012)
- Volume I: Introduction and CSC Framework
- Volume 2: State and Local Government
- Volume 3: EMS
- Volume 4: Hospital
- Volume 5: Alternate Care System
- Volume 6: Public Engagement
- Volume 7: Appendices
-
Guidance for Establishing Crisis Standards of Care for
Use in Disaster Situations, a Letter Report
(Institute of Medicine of the National Academies, September
24, 2009).
- Allocation of Scarce Resources During Mass Casualty Events (HHS/AHRQ, June 2012) (This report represents follow-up after the 2009 IOM report.)
-
REMM table about Crisis Standards of Care
- See REMM Response Resource Availability and Crisis Standards of Care table based on the IOM constructs cited above
Incident Command System and Hospital Incident Command System
Clinical management of radiation injury issues
- Clinical algorithms
- Combined injury
- Mass casualty issues
- Hospital approach to patients presenting after a nuclear detonation
- At-risk and special needs patients and visitors
- Use of blood products
- Plan surgery before neutropenia
- Consider consultation with the Radiation Injury Treatment Network
- Acute radiation syndrome
REMM tools for hospitals
- Template for adult/pediatric orders
- Clinical algorithms
- Biodosimetry tools
- Medical countermeasures for managing radiation exposure
- Medical countermeasures for managing internal contamination
- Hospital Approach to Patients Presenting After a Nuclear Detonation
- Follow-up instructions
- Formal drills and exercises
References
HHS
- Medical Surge Capacity and Capability: the healthcare coalition in emergency response and recovery (HHS, 2009)
- Medical Surge Capacity and Capability (MSCC): a management system for integrating medical and health resources during large-scale emergencies, Second Edition (HHS 2007)
- Hospital Preparedness Program (HHS grant program)
- Hospital Preparedness Exercises Resources (HHS/AHRQ, Dec, 2010)
- Preparedness for Chemical, Biological, Radiological, Nuclear, and Explosive Events: Questionnaire for Health Care Facilities (HHS/AHRQ, 2007)
- Training of Hospital Staff to Respond to a Mass Casualty Incident (Evidence report/technical assessment number 95, AHRQ Publication No. 04-E015-2, July 2004)
- Hospital Evacuation Decision Guide (HHS/AHRQ, 2017)
Other
- Verheul ML, Dückers M. Defining and Operationalizing Disaster Preparedness in Hospitals: A Systematic Literature Review. Prehosp Disaster Med. 2020;35(1):61–68. [PubMed Citation]
- Razak S, Hignett S, Barnes J. Emergency Department Response to Chemical, Biological, Radiological, Nuclear, and Explosive Events: A Systematic Review. Prehosp Disaster Med. 2018 Oct;33(5):543-549. [PubMed Citation]
- Assessing Medical Preparedness to Respond to a Terrorist Nuclear Event. Workshop Report. (Institute of Medicine of the National Academies. June 15, 2009. Purchase required.)
- Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report, (NAS/IOM, National Academies Press, 2009)
- Responding to a Radiological or Nuclear Terrorism Incident: A Guide for Decision Makers (PDF - 1.61 MB) (NCRP Report No. 165, National Council on Radiation Protection and Measurements, Bethesda, MD, 2010)
- Developing Radiation Emergency Plans for Academic, Medical or Industrial Facilities (NCRP Report No. 111), National Council on Radiation Protection and Measurements, Bethesda, MD, 1991.
- Dainiak N, Delli Carpini D, Bohan M, Werdmann M, Wilds E, Barlow A, Beck C, Cheng D, Daly N, Glazer P, Mas P, Nath R, Piontek G, Price K, Albanese J, Roberts K, Salner AL, Rockwell S. Development of a statewide hospital plan for radiologic emergencies. Int J Radiat Oncol Biol Phys. 2006 May 1;65(1):16-24 [PubMed Citation]
- Radiological Attack - Radiological Dispersal Devices (PDF - 127 KB) (The California Emergency Medical Services Authority)