Community Hardening: Radiation Melinda Johnson Denver MMRS Program - - PowerPoint PPT Presentation

Community Hardening: Radiation

Melinda Johnson Denver MMRS Program Coordinator melinda.johnson@rmpdc.org

Welcome!

Session Goal:

To understand how one community calculated the

risks of radiation exposure and the steps taken to mitigate that risk.

To leave with the knowledge necessary to begin

such a program within your community.

Session Objectives

Identify ways to determine community risk of

radiation exposure.

Understand what needed services are most at

risk to radiation contamination.

Identify ways to protect, prevent, respond and

eventually recover from a radiation exposure incident.

Why is this needed?

National Planning Scenarios 1 & 11

Unknown/uncertain contamination Self-referring victims Surreptitious exposure

Radiations of concern

Penetrating/non-penetrating External vs. internal

Contamination control Recognition that First Receivers were a gap in

planning

Types of Exposures

Radiological Accidents:

Healthcare facilities, specialized imaging centers,

medical waste facilities.

Industrial or transportation incidents.

Terrorism Scenarios:

Dirty Bomb Radioactive Device

Radiological Materials

Millions of radioactive sealed sources are used around the world for

legitimate and beneficial commercial applications such as cancer treatment, food and blood sterilization, oil exploration, remote electricity generation, radiography, and scientific research. These applications use isotopes such as Americium-241, Californium-252, Cesium-137, Cobalt-60, Curium-244, Iridium-192, Plutonium-238, Plutonium-239, Radium-226, and Strontium-90. Many of these radiological sources are no longer needed and have been abandoned or orphaned; others are lightly guarded, making the threat of theft or sabotage significant. Currently, there are thousands

• f civilian locations worldwide with dangerous high activity radioactive

sources.

1,000 curies of radioactivity (about the size of a roll of coins) is all that is

needed to make a large radiological dirty bomb.

Step One – Identification of Need

While conducting all hazards planning each region

conducts a vulnerability assessment.

This assessment raised our awareness of the numbers

• f facilities that we knew had radioactive sources –

and those whom we only suspected had them.

We realized that should there be a problem with one

• f those sources, we wouldn’t know, and wouldn’t

have been able to respond.

Step Two – What are the Risks?

In examining the sources in our community we also

had to think about the realistic risks:

Leaks Abandoned Sources Stolen Sources And less likely – a Terrorist Attack (aka Dirty Bomb)

Who would be impacted?

Infrastructure – Hospitals, government buildings, etc. EMS Law Enforcement

Dirty Bomb

• The term dirty bomb is primarily used to refer to a radiological dispersal device

(RDD), a speculative radiological weapon which combines radioactive material with conventional explosives. Though an RDD would be designed to disperse radioactive material over a large area, a bomb that uses conventional explosives would likely have more immediate lethal effect than the radioactive material. At levels created from most probable sources, not enough radiation would be present to cause severe illness or death.

• Since a dirty bomb is unlikely to cause many deaths, many do not consider this to

be a weapon of mass destruction. Its purpose would presumably be to create psychological, not physical, harm through ignorance, mass panic, and terror. For this reason dirty bombs are sometimes called "weapons of mass disruption". Additionally, containment and decontamination of thousands of victims, as well as decontamination of the affected area might require considerable time and expense, rendering areas partly unusable and causing economic damage.

• No dirty bomb has been used, though unexploded devices have been developed.

Step Three: Deciding what to Do

Once we looked at the risks and decided that

yes, we needed to take some action we had to decide WHAT to do.

Strategies include purchasing of

pharmaceuticals and equipment, outfitting and training decontamination teams - both hospital and fire based, as well as work with EMS to protect them post-exposure.

Step Four: Setting the Table

Who needs to be there?

Emergency Managers Toxicologists Hospitals Private Sector Partners EMS DHS/HHS Grantees (they have the $$) Law Enforcement (CAIC) Fire Departments – decontamination response

Step Five: What Can We DO?

Protect

Encourage private sector partners to protect their

sources and if possible participate in government programs that assist them with this.

In determining how to best protect a facility from

contamination from radiation we elected to use a wall mounted portal radiation device.

Purchase dosimeters for fire and law enforcement.

Equipment

Due to the cost of the

equipment we approached our State Homeland Security Grant program and asked for funds to purchase Ludlum area monitors and survey meters.

Stockpiling

There are many differing opinions on

stockpiling pharmaceuticals for response to a radiological event.

Where stockpiling is occurring it is without

standardized guidance.

Everyone is essentially “doing their own thing”

with regard to stockpiling.

Stockpiling

For example, there are 124 MMRS cities in the United States, they have

been tasked with stockpiling pharmaceuticals in the event of a disaster, however they have received no guidance on radiation stockpiles and each community is left to it’s own devices and decisions.

The Problem with Stockpiling

The Problem with Stockpiling

Antidotes and treatments are expensive Have limited shelf-lives Likely to be used in large quantities, but

rarely

The Problem with NOT Stockpiling

Staff Fear – will they want to respond if they

are in danger of exposure?

These antidotes are most effective when

administered immediately after exposure, or in the case of KI, before exposure. Do you have time to wait to receive the drugs?

The Strategic National Stockpile

A Federally Funded Repository of: Antibiotics Vaccines Immunoglobulins Chemical antidotes Radiation antidotes Antitoxins Life-support medications IV administration Airway maintenance supplies Medical/surgical items

SNS Push Packages

Strategically located

throughout U.S.

Supplement and

re-supply state and local public health agencies in the event of a national emergency

The SNS can be shipped

anywhere within the U.S. or its territories and should arrive to the scene within 12 hours

Stockpiling Questions

Where should you stockpile?

Local, i.e. Hospitals Community Region National, i.e. Strategic National Stockpile

How much do you stockpile? How do you

know you have enough?

Stockpiling Determinations

The decisions of if and how to stockpile medical

countermeasures should be made after comprehensive threat and vulnerability assessments are conducted at the national, state, regional and local levels.

These assessments are then combined with the modeling of

plausible scenarios. Once combined, these activities can provide an estimate of the number of persons who might be exposed if an even were to occur.

For any stockpiling program to work, activation, distribution

and local incident management systems must be in place and exercised.

Stockpiling Determinations

Another helpful tool in determining how

much Prussian blue to stockpile is a program developed by Johns Hopkins University called the Electronic Mass Casualty Assessment & Planning Scenarios - EMCAPS.

This tool is free and may be downloaded from: http://www.hopkins-cepar.org/EMCAPS/EMCAPS.html

What did WE do?

We worked with the toxicologists from the Rocky

Mountain Poison and Drug Center to determine what our exposure risks were, and what we should stockpile.

We have purchased the following:

Radiogardase (Prussian Blue) SKKI Duo Dotes Cyano kits Antibiotics

Concept of Operations

We have a risk of radiological exposure. We have a need to protect valuable assets, i.e.

hospitals & EMS from contamination.

If there is contamination we need a way to

determine what it is and how to treat it.

Decontamination

In our 10-County Region the two MMRS programs

have equipped 5 mass decontamination teams.

Fire Based Able to respond within 30 minutes Able to decontaminate large numbers of people Able to decontaminate equipment Has an associated HAZMAT team

We have also equipped hospitals with interoperable

decontamination equipment and training.

Communications

One reoccurring issue is how to communicate to

first-responders that they may have been exposed?

What you do regularly works best. Use the same mechanism currently in place for infectious

disease notification.

If law enforcement or fire are the first to discover

radioactivity they notify dispatch who notifies

• hospitals. If this step fails, the detectors will alarm

notifying hospitals.

Plans, Training & Exercise

We worked with individual hospitals to have

response plans in place when the detector actually goes off.

Part of this involved training from Susan

Eckhert of Health One in Washington DC.

Susan headed an HHS funded study on radiation

monitoring in hospital emergency departments.

Plans, Training & Exercise

Part of the planning process was to engage

hospitals, law enforcement and fire departments to understand who had what responsibility when the alarm sounded.

The second step is to exercise the plans:

Tabletops Drills Full scale

Plans, Training & Exercise

MMRS also worked with the State and the

Center for Domestic Preparedness (CDP) to train hospital response teams in appropriate decontamination protocols and processes.

What PPE to use? How much treatment to give prior to decon? How to assemble and staff a team?

Results

While still a work in progress, the North

Central Region of Colorado is prepared to respond to a radiological emergency by treating patients for specific types of radioactive exposure, protect hospitals (and working on other public buildings) from contamination and know how to communicate exposure risks back to first responders.

Resources

www.remm.nlm.gov for a comprehensive overview of

medical management of radiological events. Radiation

Event Medical Management (REMM) was produced by the Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Office of Planning and Emergency Operations, in cooperation with the National Library of Medicine, Division of Specialized Information Services, with subject matter experts from the National Cancer Institute, the Centers for Disease Control and Prevention, and many US and international consultants.

www.doe.gov Department of Energy https://cdp.dhs.gov/ Center for Domestic

Preparedness

http://nnsa.energy.gov/nuclear_nonproliferation/1550.

htm Global Threat Reduction Initiative (GTRI)