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Monitoring the Public for Radiation Gregg D. Dempsey Senior Science Advisor Radiation and Indoor Environments National Laboratory April 14, 2004.

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Presentation on theme: "Monitoring the Public for Radiation Gregg D. Dempsey Senior Science Advisor Radiation and Indoor Environments National Laboratory April 14, 2004."— Presentation transcript:

1 Monitoring the Public for Radiation Gregg D. Dempsey Senior Science Advisor Radiation and Indoor Environments National Laboratory April 14, 2004

2 Monitoring the Public for Radiation If there are more than 10-15 members of the public at the incident scene and there’s radiation, you may be overwhelmed. Once you get beyond your capacities – a special area needs to be set up FAST to monitor victims. Eventually you’ll send them home or to a shelter – have guidance ready. This is a little different than a chemical incident, so different techniques apply.

3 Information is the Key to Success Have the media relations people get on the radio and TV with your message – FAST. Get out initial guidance and make sure it’s consistent. If you need to have people return for monitoring, have a location and a plan. Have written guidance available for anyone who is monitored.

4 Good Information is Vital

5 For Immediate Release Comes from local authority: mayor, ER manager, Fire Chief, Police Chief, etc. Quickly gets on radio and TV Gives good instructions – shelter, shower, don’t go to hospital unless needed, watch for more information. Let’s the public know as you get more information, the guidance might change.

6 Monitoring the Public for Radiation Resist the urge to wet everything and everyone down – with the public and certain weather conditions, that may be a big mistake. Some of the public will have left the scene before you get there – don’t stress – that’s ok. Get your media relations people working on that. Get serious medical problems to the hospital. Don’t wait because someone may be contaminated. Lifesaving first.

7 Monitoring the Public for Radiation HOWEVER, multiple hazard incidents require another look. In a hazmat and radiation incident, the hazmat consideration may be more important.

8 So let’s say you have 100-1000 victims, and it’s beyond your capabilities. What do you do? Let’s look at what has happened to others first.

9 Case Study: Goiania, Brazil September 1987 – abandoned cancer treatment teletherapy device source container opened Cesium-137 – 1375 curies Not discovered for almost 2 weeks Localized to a city center Cesium didn’t move well in environment – bound up fairly quickly

10 Case Study: Goiania, Brazil Houses and dirt had to be removed Massive PR problem 112,000 people monitored in the weeks after the breach 4 deaths 22 needing intensive care

11 From a Brazilian Presentation on Goiania Old Clinic Population monitoring Mobile radiation monitoring: NaI and GM detectors mounted on a car Police Official being monitored

12 Case Study: Chernobyl, Ukraine April, 1986 – “power excursion” accident at reactor site Huge fire releases thousands of curies of radiation per day World-wide detection of radiation Hundreds of thousands of people affected; thousands contaminated with little initial follow up 100 deaths? (an arguable point)

13 Case Study: Chernobyl, Ukraine “Chernobyl Zone” still under government control – now a specific government agency in Ukraine. Pripyat, a town near Chernobyl, abandoned. The reactor, entombed – poorly.

14 Case Study: Chernobyl, Ukraine

15 Been there – done that. Inside the Chernobyl Control Room.

16 Pripyat, Ukraine An abandoned city

17 Chernobyl, Unit 4 The Sarcophagus

18 Monitoring and Decon Center Estimate the number of people you think might have been affected by the event – then triple it. Find a facility nearby that can handle that load. If no facility, you’ll have to do it outside. Get ready, it will be night soon. What’s going to happen with the weather? You’ll need people with radiation monitors able to see the radionuclide(s) used in the incident.

19 Monitoring and Decon Center If you monitor a group of people in a first response, more will ask for monitoring soon. In the hours and days that follow, it might look to you that the “problem” this is spiraling out of control. Expect this. The “site” hasn’t gotten larger, but the public’s fear has.

20 Monitoring and Decon Center Workers will be needed to form lines, manage the center. Can you decon those that need it? Can you protect the facility, or decon it if it becomes contaminated? Non-technical staff will be needed to gather important information.

21 Monitoring and Decon Center The goal is to get as many people through monitoring as fast as we possibly can. That doesn’t mean they won’t have to be re-monitored later. By accomplishing monitoring quickly, you can retain some control Expect federal help.

22 Monitoring and Decon Center In the next slides, we’ll go through a triage system which can be used for population monitoring. But first, I need to undo some of your prior training:

23 Contamination is bad.

24 DECONTAMINATE! Contaminated?

25 WHY? “We were trained that way.” “We have to reduce a potential health effect.” “Contamination is bad.”

26 Will there be a health effect? ???

27 Population Monitoring and Decontamination Problems How many people are there? How many people do I have to help monitor? Are the survey instruments the right type? How many survey instruments do I have? Are decon supplies adequate? Do I have clothing for the contaminated? Who can do the Registry stuff? Do I have a decontamination facility or can I set one up? *#!?@ HELP!

28 The Biggest Problem: I’ve got more people than I can possibly handle and I don’t have enough help.

29 Get Name/Give Info. NO Shelter or Home Is the person contaminated??

30 Shelter/Home Outta My Hands...

31 YES NO Advise “self decon” at home Name/Registry Stuff Shelter/Home Is the person contaminated? Would leaving contamination in place cause a health effect?

32 YES Does hand and foot decon remove 85% of contamination? Advise “self decon” at home Name/Registry Stuff Shelter/Home Is the person contaminated? Would leaving contamination in place cause a health effect? YES

33 Does hand and foot decon remove 85% of contamination? Name/Registry Stuff Semi-supervised “self-decon” (shower or wipe) Contamination gone or sign. lessened? NO Shelter/Home Yes Is the person contaminated? Would leaving contamination in place cause a health effect? NO

34 YES Does hand and foot decon remove 85% of contamination? NO Advise “self decon” at home Name/Registry Stuff Advise “self decon” at home Supervised “self-decon” Name/Registry Stuff Contamination gone or sign. lessened? NO Shelter/Home Yes Is the person contaminated? Would leaving contamination in place cause a health effect? NO YES Get Name/Give Info. NO

35 The goal is to get as many people through monitoring as fast as we possibly can.

36 And we’re going to remove anyone from our monitoring line that might slow it down or might need special assistance.

37 And in this process, we’re going to identify those that really really need our help.

38 People to be Removed from Monitoring/Decontamination Line by Monitors Anyone obviously contaminated (readings on meter) Families with children less than 5 years old Children alone (those less than 18 years old) Individuals showing obvious medical problems or who require medical attention* *Judgment call

39 People to be Removed from Monitoring/Decontamination Line by Monitors Anyone handicapped (wheelchair, walker, blind, deaf, etc.)* Adults over 70 years* Individuals with language issues* Individuals with no identification Individuals pregnant or who appear pregnant* *Judgment call

40 People to be Removed from Monitoring/Decontamination Line by Monitors Individuals with cultural issues which might complicate monitoring or decontamination* Perps Individuals who appear extremely stressed out* Important: families always accompany an individual removed from the line *Judgment call

41 If Someone Is Removed From the Line If someone can care for them (besides you) that’s a good thing! England uses the concept of “carers” which we would call “caregivers” – Recruit caregivers or other volunteers as you can. They can even be neighbors or friends. Watch for stress-related problems.

42 First Survey (Ambulatory Adults and Children) Hands and feet first (α,β,and (), then perhaps the person’s face Portal Monitor (Covers ( only, if available) If they pass, get their name and send them home or to a shelter (with instructions)

43 Pass? What’s Pass? Not being contaminated or being lightly contaminated might be a moving target depending on the number of victims. Someone might be able to go home partially contaminated with instructions. Get quick guidance from federal officials. The National Response Center can route a call: (800) 424-8802.

44 Until You Know Monitor alpha, beta, and gamma Once the radionuclide(s) are identified, monitoring might be easier, but… For certain radionuclides, external monitoring may be impossible (then bioassay may be needed, ugh…)

45 Contrary to Popular Belief This is NOT like going through the Metal Detector at the Airport Wow, no one at the security point? This must be a dream…

46 At the airport: You’re probably not a terrorist. You’re probably not carrying contraband. You know eventually you’ll get through (even if you get a hassle). Even worst case – you don’t get through – your health won’t suffer as a result.

47 In a Contamination Monitoring Line: You don’t know if you’re contaminated or not. Um, what does “contaminated” mean? You don’t know if the person next to you or a family member is contaminated. You don’t understand what’s going on and you probably were involved in a traumatic event just a little while before. And if you are contaminated, what happens next and how might that impact your health?

48 If your monitoring is this smooth…

49 Try not to overwhelm a victim with monitors

50 Monitoring Techniques Use the same radiation monitoring techniques you’ve been taught with hand- held survey equipment. Explain what you’re doing and leave the speaker OFF. Answer questions but keep the line moving.

51 Certain groups for religious or cultural reasons may not want to participate in monitoring or decon. What then?

52 So how do I handle these groups? Understand the cultural diversity concerns you might have to address. Understand that people who are heavily clothed are probably not contaminated beyond their face, hands, and feet. Use a simpler concept: rinse, wipe, rinse.

53 Undomiciled victims also have special needs. Many homeless people may be living in shelters or out on the street and will probably be able to go through monitoring and decon no problem. People may show up with many personal belongings (shopping carts) Some individuals may have mental health issues Some other individuals may have drug dependency problems Heavy interaction from local Social Services is vital in serving these groups.

54 For others that are contaminated: If they really need a decon shower – they wash themselves, assisted, if necessary. Soap and water, rinse, dry off, then re- monitor. Afford some privacy. Back to the shower if they don’t get it the first time. If it continues to be a problem, seek additional assistance.

55 Not Recommended Ladder trucks and fogger nozzles Cold tap or hydrant water Showering in clothing Responders scrubbing down the public

56 Not Recommended While this might be fine for your own crews, don’t do this with the general public.

57 Not Recommended Avoid any recreation of the “shower scene” from the movie Silkwood - no aggressive scrubbing!

58 Where does the water go? In a monitoring or decon facility – my initial recommendation to you is to let the water go down the drain. In a totally outside monitoring situation – route the water to a sanitary sewer. If there’s a way to control highly contaminated water, do so. Otherwise, don’t worry about it.

59 Additional Concerns Remember, people will need to shed heavily contaminated clothing – if they don’t, there may be a health effect Monitoring Center, Reception Area, or Shelter must be carefully managed to avoid cross contamination Personal dignity and privacy concerns are paramount No perception of forced action on any person No perception of concentration camp, detention center or prison in clothing provided to the contaminated

60 For those that are not contaminated or not significantly contaminated: Send them home with instructions for a good shower. Use the “I’m really muddy” scenario – strip at the door. Instructions include bagging clothing and holding it.

61 Self-Decontamination

62 Registry Issues According to the Russians and Ukrainians, the biggest mistake they made after Chernobyl was not having a registry of victims started until weeks after the accident. A registration of victims helps determine status for later claims, both health and legal. Workers should be in this registry too. Gather pertinent information in a fashion similar to other disasters. Add monitoring information to that file. Computerize what you can. The Centers for Disease Control will ultimately establish a detailed registry. You start the process.

63 Clothing Issues If someone is contaminated and we remove their contaminated clothing, we have to re- clothe them somehow. Everyone I’ve asked about decontamination was willing to wear a hospital scrub suit home. But they don’t come in baby and childrens sizes.

64 Clothing Sizes for 99% of the US T-Shirts/Sweat Pants: Infant Sizes: 3 Months, 6 Months, 9 Months, 18 Months, 2T, 3T Youth Sizes: YS Scrub Suit Combos: Adult Sizes: XS, S, M, L, XL, 2XL, 3XL, 4XL, 5XL, 6XL

65 Scrub Suit Colors Available From One Manufacturer

66 Clothing Options in Evacuation and Shelter Areas Blankets can be used for coats or serapes. Certain people might require same-sex help. Your local Red Cross might be able to assist. I don’t recommend giving away all your tyveks.

67 Sources of Clothing and Towels –Hospitals –School PE Programs –Retail Stores in the Area –Some larger emergency response groups might want to purchase scrubs, clothing, towels for a generic terrorist action and store it.

68 We need more supplies, food, clothing, towels, and in a hurry!

69 Guess what this is…

70 Retail Power in the United States* Wal-Mart –Regular Wal-Marts - 1353 stores –Wal-Mart SuperCenters – 1713 stores –Sam’s Club – 552 stores –110 distribution centers K- Mart - 1100 stores –18 distribution centers Target – 1250 stores –22 distribution centers *information pulled from the individual company websites 4/05

71 Grocery Chains* Kroger, Inc. – 2542 stores (includes Ralphs, Fred Meyer, Food4Less, King Soopers, Smith’s, Fry’s, Dillons, QFC, City Market, Hilander, Pay Less, Owens, Kessel, others, w. common ordering system) Albertsons – 2300 stores (19 distribution centers) Safeway, Inc. – 1820 stores (including Vons, Randalls, Carrs) Food Lion – 1200 stores (7 distribution centers) Winn Dixie – 1070 stores (including Jitney-Jungle, Sack & Save, Delchamps, MegaMarket) Publix – 851 stores (8 distribution centers) Piggly Wiggly – 600 stores HEB/Pantry – 300 stores Giant Foods – 202 stores (2 distribution centers) Raley’s, Inc. – 185 stores (includes Bel Air, Nob Hill, Food Source) Meijer – 150 stores Harris Teeter – 143 stores (2 distribution centers) Bashas’ – 127 stores Dominick’s – 99 stores Food City – 85 stores *information pulled from the individual company websites 6/03

72 Reach-Back Late afternoon/early evening resupply EVERYDAY Large inventory at distribution centers Seasonal items not in season may still be in distribution center Most use computerized ordering/tracking system Regional/District Managers might be able to move mountains within that company Large companies have clout with their suppliers Most of these companies will be quite willing to help Participation in emergency response effort ultimately good for business

73 What Can They Supply? Bottled water, soft drinks, Gatorade-type drinks Pastries, cookies and other boxed cake products Plastic bags, all types; plastic sheeting Coolers, ice Catering services, pre-packaged “lunchables” Bulk decontamination supplies (soap, pre-treats, etc.) Seasonal items perhaps even “off season” –Plastic chairs –Sandals/Flip-Flops –Blankets, towels –Clothing items

74 Protect the Monitoring and Decon Facility Monitor the floor quite a bit. Someone can track radiation all over the facility fast if unchecked. Use the same control area concept, hot line concepts, etc., as in a first response. Cover things in plastic that won’t be used – this will protect them.

75 Where can I get plastic, visquene, rubber mats, privacy barriers, etc.?

76 Ok, guess who this is…

77 No, it’s Lowe’s home improvement centers 1075 stores, adding about 100 per year Home Depot 1800 stores, adding about 200 per year Don’t forget your local lumber yard, hardware store, garden shop.

78 Handle Contaminated Clothing Individually bag and label contaminated clothing removed from victims – they will probably be re-evaluated later. Return valuables, even if contaminated, in plastic bags. Decon if possible.

79 Dealing With Automobiles Don’t deal with automobiles initially. Isolate the contaminated ones if that’s an issue. Monitor wheel wells for evidence of further contamination. If you have to deal with automobiles, a good regular car wash will probably remove the majority of the contamination. The interiors of cars which are contaminated might be a particular issue – floor mats could be a problem too.

80 Dealing With Automobiles

81 Correct – just don’t recycle the water.

82 Dealing With Automobiles Incorrect.

83 Dealing With Pets Many shelters won’t allow pets. Many people won’t part with their pets. If someone shows up with a pet or guide dog, monitor it adjacent to the people monitoring area. If you have to give advice – the same decon procedures used for the population work here. A warm soapy bath followed with a thorough rinse will probably remove the majority of the contamination.

84 Shift Work Your monitoring and decon operation will take longer than you can possibly imagine. This is physically tiring, be prepared to change out workers. Call for assistance, even NYC needed help for 9-11 FEMA and Homeland Security will provide assistance in logistics, the Centers for Disease Control for long-term Registry.

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