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Develop a Radiation Emergency
Medical Response Plan

Important General Issues


  • A mass casualty radiation response plan requires collaboration among
    • Healthcare professionals from many different specialties
    • Professionals from many other response disciplines, including first responders, security, law enforcement, and many others
    • Governmental (tribal, local, city, county, State, Federal) and non-governmental entities
  • Planning responses for a large mass casualty radiation event requires
    • Generic (all types of hazards) responses activities
    • Activities unique to any radiation event
    • Medical activities appropriate for the specific kind of radiation event that develops
    • Developing, equipping, training and exercising response teams on a regular basis
  • Considerable Federal, State and local planning for potential radiation events has already been done.
    • See REMM: Planners - Preparedness and Response
    • Those making new radiation response plans should
      • Know about plans that already exist in their jurisdiction
      • Consider how their new (medical and overall) plans optimally integrate into existing plans, which are continually updated.
  • In a large, national radiation emergency, the Department of Homeland Security or another federal agency like the Department of Defense, is likely to be asked to play a large role in directing the federal response.
    • Nevertheless, local/regional response activities will occur before, during and after the Federal response is activated.
  • The new National Response Framework (PDF - 1.42 MB) (Fourth Edition, DHS/FEMA, October 28, 2019) and its associated documents describe specifically how governmental and non-governmental entities must collaborate in various types of catastrophic national emergencies, including mass casualty radiation emergencies.
  • Plans for managing hospital activities in a large mass casualty event have also been established.
    • As new individual health care facility plans are developed, they must be integrated into existing plans involving tribal, local, regional, and State public health responses activities.
    • Coordinating the activities of all medical and non-medical responders is absolutely critical.
  • Guidance on creating, and implementing "Crisis Standards of Care" is the subject of an important series of 7 monographs from the IOM (National Academies) cited on the REMM standards of care page.

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Planning Guidance for Response to a Nuclear Detonation


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Develop a State Radiation Response Plan


State Radiation Preparedness ProgramD

Adapted from Dainiak N et al. Development of a statewide hospital plan for radiologic emergencies. Int J Radiat Oncol Biol Phys. 2006 May 1;65(1):16-24. [PubMed Citation]

See also:

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Develop a Generic Facility Radiation Incident Response Plan


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Develop a Community Hospital Response Plan

Jafari ME, Radiological incident preparedness for community hospitals: a demonstration project. Health Physics 99 Suppl 2: S123-35. [PubMed Citation] Note: see list of equipment, job action cards, development of a response plan, training recommendations.

 

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Develop a Hospital Response Team


Adapted from Dainiak N et al. 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 Emergency Medical Response Team Members

Role Responsibilities
Radiation safety officer
  • Primary individual responsible for radiological monitoring
  • Assists emergency department and triage staff in determination of the classification of victims
  • Provides guidance and preparation of decontamination space
  • Directs and conducts survey, monitoring, and decontamination
  • Estimates risk by measurement of dose rate,
  • Documents and records all measurements
  • Conveys information of dose and risk to medical caregivers
  • Directs collection of blood and other biologic samples that might be required
  • Considers obtaining informed consent before allowing ED staff to work in high or very high dose rate areas
  • Directs monitoring radiation doses of patients and response personnel (issuing badges to all workers in moderate to high dose rate areas)
  • Assesses contamination of areas used in the administration of care to patients
  • Reports of level of risk to clinicians and medical caregivers
  • Considers reclassifying dose rate each hour and rotating staff if indicated
Emergency department personnel: physicians/nurses
  • Primary individuals responsible for the care of the patient is the emergency department medical director or, if unavailable, the emergency department physician assigned to trauma cases.
  • Physician is responsible for assuring that medical and surgical care is administered in a timely and effective manner.
  • Nurse is usually the primary individual responsible for initial activation of the radiation event hospital protocol is usually the emergency department nurse supervisor.
  • Nurse supervisor is responsible for assuring that the various aspects of the pre-approved radiation event protocol are properly implemented.
Nuclear medicine personnel
  • Assists the Radiation Safety Staff in the collection, storage, and analysis of samples, provide assistance and routine monitoring of personnel and equipment in the decontamination area
  • Assists in the analysis of area and personnel contamination wipe tests, provide assistance in the monitoring of emergency transportation vehicles, and perform other duties related to radiation safety and protection, as directed by the radiation safety officer.
Hospital safety/security coordinator
(Administrator on call)
  • Oversees the security operation to restrict unauthorized personnel from entering the hospital radiation decontamination area or other critical areas of the hospital,
  • Notifies state or federal officials if the situation requires assistance in excess of the hospital's capacity
  • Assigns adequate personnel at the entrance of the hospital to restrict entry to the hospital to only those persons that are required for either operation of the hospital or implementation of the radiation disaster protocol
  • Directs incoming ambulances to the proper hospital entrance as directed by the emergency department physician, radiation safety officer, or designees
  • Secures the emergency medical services vehicle and prevents removal from hospital grounds until cleared by radiation safety staff, and reserves designated routes as needed.
Nursing staff
  • Provides staffing in the emergency department, operating room, and elsewhere in the hospital
  • Assists in decontamination, treatment, and psychological support of victims under the direction of radiation safety staff, emergency department staff, and hospital staff
Physician and Allied Health specialists with relevant expertise who must be part of the response teams
  • Radiation Oncologists
  • Medical Oncologists/Hematologists
  • Pediatric Oncologists
  • Psychiatrists
  • Blood Bank personnel
  • Psychologists
  • Social Workers
  • Trauma and Burn Care
  • Pulmonary
  • Toxicology
  • Pharmacy
Engineering/ housekeeping staff
  • Organizes and sets up decontamination area
  • Provide plastic-lined waste containers and other supplies as needed in the emergency department for decontamination, with assistance from operating room personnel, radiation oncology personnel, and laboratory personnel will assist as indicated, following the radiation protocol and direction of radiation safety staff
  • Will remove nonessential items of furniture from the decontamination area before arrival of the accident victims. They will participate in space clean-up as directed by radiation safety staff.
Public Information Officer
  • Releases approved incident information to the public, media
Security
  • Secures hospital grounds, perimeter, ED access, contaminated and uncontaminated areas of the ED, and hospital including Radiology, OR etc.

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