First Responders:
Information for Radiation Emergencies

General

• First Responder Capability (DHS)
  • See also: Psychological First Aid
• Manual for First Responders to a Radiological Emergency (PDF - 2.2 MB) (CTIF, IAEA, PAHO, WHO, October 2006)
• Portable First Responder Assistant - A Tool for First Responders to a Radiological Emergency (IAEA, 2008)
• Help for "First Responders" to Nuclear or Radiological Emergencies. The IAEA Issues Key Guidance to Local Emergency Response Team (IAEA, December 22, 2006)
• Preparedness and Response for a Nuclear or Radiological Emergency (PDF - 314 KB) (IAEA Safety Standards Series No. GS-R-2, FAO, IAEA, ILO, OECD/NEA, PAHO, OCHA, WHO, 2002)
• What To Do in a Radiological Emergency (IAEA)
• Hazardous Waste Operations and Emergency Response Standard (HAZWOPER) — FAQ (OSHA)
• Response Actions at Radiation Incidents : A Typical EMS Standard Operating Procedure (PDF - 79 KB) (Health Physics Society, June 25, 2004)
• Becker SM, Middleton SA. Improving hospital preparedness for radiological terrorism: perspectives from emergency department physicians and nurses. Disaster Med Public Health Prep. 2008 Oct;2(3):174-84. [PubMed Citation]

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Personal Protective Equipment

• Personal Protective Equipment
• Practical Radiation Technical Manual, Personal Protective Equipment (PDF - 439 KB) (IAEA, 2004)
• Development of Models for Emergency Preparedness, Personal Protection Equipment, Decontamination, Isolation/Quarantine, and Laboratory Capacity (PDF - 4,715 KB) (AHRQ, 2005)
• OSHA Best Practices for Hospital-based First Receivers of Victims (OSHA, section B, January 2005, 1.93 MB)
  

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Initial Actions for Responders after a 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)

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National Assets Responding to a Large Radiation Incident

• DOE Radiation Incident Response Assets
• Approximately Time in Hours for Early Federal Technical Response Activities and Teams after a Nuclear Detonation
• For a full list of agencies and their responsibilities after a nuclear detonation see the Nuclear/Radiologic Incident Annex to the Response and Recovery Federal Interagency Operational Plans, May 2023 — Final. See pages 24-38.

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Casualty Management

• Casualty Management After a Deliberate Release of Radioactive Material (HHS/CDC)
• Training: "Radiological Terrorism: Medical Response to Mass Casualties" (HHS/CDC)
• Management of Terrorist Events Involving Radioactive Material (NCRP Report No. 138), National Council on Radiation Protection and Measurements, Bethesda, MD, 2001. (See Chapter 9: Radiological Consequence Management Considerations, p. 110.)
• Generic Procedures for Medical Response during a Nuclear or Radiological Emergency (PDF - 2,225 KB) (IAEA, Section C, Response at the Scene (at Pre-Hospital Level), pages 42 - 53, April 2005)

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Protective Action Guides

• Emergency Worker Exposure Guidelines in the Early Phase of a Radiation Incident

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Emergency Responder Health Monitoring and Surveillance

• Emergency Responder Health Monitoring and Surveillance, National Response Team Technical Assistance Document (PDF - 4.5 MB) (US Government Interagency group led by NIOSH and coordinated with the National Response Team, January 26, 2012) Note: this document includes radiation issues generically, but not specifically.
• Emergency Responder Health Monitoring and Surveillance, A Guide for Key Decision Makers (PDF - 383 KB) (US Government Interagency group led by NIOSH and coordinated with the National Response Team, January 26, 2012) Note: this document includes radiation issues generically, but not specifically.

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Triage in the Field

• Algorithms: Trauma Triage
  • "START" Algorithm (Adults)
    • Simple Triage and Rapid Treatment Triage Cards (Critical Illness and Trauma Foundation, Inc.)
    • Simple Triage and Rapid Treatment (START) Technique (Wikipedia)
  • JumpSTART Pediatric Multiple Casualty Incident Triage (Dr. Lou E. Romig, MD, Team Life Support, Inc.)
    • JumpSTART Pediatric Multiple Casualty Incidents Triage Tool (Dr. Lou E. Romig, MD, Team Life Support, Inc.)
    • JumpSTART Algorithm (Children)
  • SALT Mass Casualty Triage Algorithm adapted for Large Radiation Emergencies
  • Generic Procedures for Medical Response during a Nuclear or Radiological Emergency (PDF - 2,225 KB) (IAEA, Section C, Response at the Scene (at Pre-Hospital Level), pages 42 - 53, April 2005)
  • See also:
    • Other primary mass casualty systems
• Algorithms: Radiation Triage
  • Contamination
  • Exposure
    • Scarce Resources Triage Tool
  • Exposure + Contamination
  • See also:
    • Other radiation triage algorithms and systems
    • Hospital Approach to Patients Presenting After a Nuclear Detonation

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HazMat

• Managing Radiation Emergencies: Identification of the Hazard (REAC/TS)
• Emergency Response Guidebook (ERG): A Guidebook Intended for use by First Responders During the Initial Phase of a Transportation Incident Involving Dangerous Goods/Hazardous Materials (DOT, 2016)
  • Guidebook downloadable in pdf format (PDF - 4.78 MB)
    • Hazard Classification System (9 classes): page 6
    • Radiation Hazard Markings/Labels/Placards: page 9
    • Hazard ID Numbers: pages 16-19
    • Radioactive Materials Information: pages 259-270
  • ERG Mobile apps
    • Supplementary app: CBRN App
      • Includes excellent resources for initial first responders on scene who suspect a potential Radiological /Nuclear emergency incident
      • Link to initial activities video listed in the "Table of Contents" as "Radiological and Nuclear" (video 2:09)
      • Links to R/N training videos and documents listed in the "Table of Contents" page on page labeled "Training Videos/Docs"
      • Downloadable in Apple store with search for "CBRN"
      • App developed in partnership between the Vermont Department of Health, Saint Michael's College Department of Public Safety and Saint Michael's College Fire and Rescue.
      • Designed to supplement the US DOT Emergency Response Guide (ERG), but not replace it.
• How to Handle Radioactive Material Packages, a Guide for Cargo Handlers (PDF - 886 KB) (Department of Transportation, September 2006)
• DOE Environmental Management (EM) Transportation Emergency Preparedness Program (Department of Energy)
• Transportation Emergency Preparedness Program Emergency Responder Radioactive Material Quick Reference Sheet (PDF - 461 KB) (DOE Transportation Emergency Preparedness Program)

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Responder Willingness to Serve During Radiation Disasters

• Balicer RD, Catlett CL, Barnett DJ, Thompson CB, Hsu EB, Morton MJ, Semon NL, Watson CM, Gwon HS, Links JM. Characterizing hospital workers' willingness to respond to a radiological event. PLoS One. 2011;6(10):e25327. [PubMed Citation]
• Sheikh S, McCormick LC, Pevear J, Adoff S, Walter FG, Kazzi ZN, Radiological preparedness-awareness and attitudes: a cross-sectional survey of emergency medicine residents and physicians at three academic institutions in the United States. Clin Toxicol (Phila). 2012 Jan;50(1):34-8. Epub 2011 Dec 19. [PubMed Citation]
• Becker SM, Middleton SA. Improving hospital preparedness for radiological terrorism: perspectives from emergency department physicians and nurses. Disaster Med Public Health Prep. 2008 Oct;2(3):174-84. [PubMed Citation]
• Smith EC, Burkle FM Jr, Archer FL. Fear, familiarity, and the perception of risk: a quantitative analysis of disaster-specific concerns of paramedics. Disaster Med Public Health Prep. 2011 Mar;5(1):46-53.
• Veenema TG, Walden B, Feinstein N, Williams J. Factors Affecting Hospital-based Nurses' Willingness to Respond to a Radiation Emergency. Disaster Med Public Health Prep. 2008 Dec;2(4):224-9. [PubMed Citation]

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Online Training Courses

• FEMA Training Centers
  • Center for Domestic Preparedness (CDP)
  • Emergency Management Institute (EMI)
  • National Training and Education Division (NTED)
• National Preparedness Course Catalog
  • Type radiation, radiological or nuclear into search box to find courses
• Listing of Incident Command (IC) and National Incident Management Systems (NIMS) courses
• FEMA Radiological Emergency Preparedness: Resources and Training

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