Protecting Yourself During a Dirty Bomb Response

Protecting Yourself During a Dirty Bomb Response
An Awareness Level Training Tool for Skilled Support Personnel Trainer Notes: Note: This training tool is not a stand alone course or curriculum. It must be tailored to meet the specific needs of the target audience and actual site. January 2008

How to Use this Training Tool
This training tool is an awareness-level health and safety resource for “skilled support personnel” who will participate in a dirty bomb response. This tool will help workers understand at an awareness level: what a dirty bomb is, the basics of radiation, how to protect against radioactive contamination and other hazards associated with a dirty bomb response. Trainers may use this tool to aid in the development of a dirty bomb awareness level course or other awareness level materials (fact-sheets, table-top activities, etc.) Trainer Notes:

Advanced/Additional Training Required for Those Involved in a Dirty Bomb Response
This training tool does not replace the radiation-specific training, additional duty specific training or PPE specific training requirements. Regardless of work scope, there are many topics covered in this awareness training tool that have corresponding OSHA standards which must be met in order to safely and legally perform associated job duties. Trainer Notes: Advanced Training is Required if: You are operating in a first response capacity (EMT Personnel, firefighter, police officer). You are operating in a first receiver capacity (emergency room staff or triage area staff). Additional Training is Required if: You use a respirator. You use Personal Protective Equipment ( PPE) such as gloves, hearing protection or eye protection. Enter confined spaces such as collapsed structures, trenches or utility vaults. Use hazardous chemicals. Are in contact with human or animal tissue or fluids. Organizations that are conducting worker specific dirty bomb training: A partial list of corresponding OSHA standards follows: Emergency Action Plans 29 CFR ; Occupational Noise Exposure 29 CFR ; Respiratory Protection 29 CFR ; Eye and Face Protection 29 CFR ; Head Protection 29 CFR ; Foot Protection 29 CFR ; Hand Protection 29 CFR ; Blood Borne Pathogens 29 CFR ; and, Hazard Communication 29 CFR 1200. Help workers be aware that additional training for certain situations might be required. Contact the NIEHS National Clearinghouse for Worker Safety and Health Training for information for advanced training on dirty bomb response,

Employer and Worker Responsibilities
Employers and workers have responsibilities under the OSH Act. The Occupational Safety and Health Act requires employers provide a safe and healthful workplace free of recognized hazards and follow OSHA standards. Employers' responsibilities also include providing training, medical examinations and recordkeeping. Workers must follow the employer's safety and health rules and wear or use all required gear and equipment; follow safe work practices for their job, as directed by their employer; report hazardous conditions to a supervisor; and report hazardous conditions to OSHA if employers do not fix them. Trainer Notes: For more information about OSHA, go to or call OSHA (6742).

Radiological Dispersion Device (RDD) “Dirty Bomb” Awareness
Module 1 Radiological Dispersion Device (RDD) “Dirty Bomb” Awareness Trainer Notes:

What is an RDD? Often referred to as a dirty bomb, an RDD uses conventional explosives or some other mechanism to spread radioactive contamination. Characteristics of RDDs: A terrorist event Low technology Low cost to make Wide range of usable radioactive materials Contamination restricts use of area until it can be decontaminated Cleanup problem Economic impact Psychological impact Spread fear (perceived danger) Trainer Notes: An RDD (dirty bomb) is any device, including any weapon or equipment, other than a nuclear explosive device, specifically designed to employ radioactive material by disseminating it to cause destruction, damage, or injury by means of the radiation produced by the decay of such material. Since this will be a terrorist event, training for response workers on evidence preservation may be required. Cesium filled package uncovered in Moscow’s Izmaylovsky Park.

An RDD is Not a Nuclear Device
A nuclear device or Improvised Nuclear Device (IND) releases an enormous amount of energy (atomic bomb) while an RDD releases a comparatively small amount of energy. Trainer Notes: Make sure the trainees understand that the difference between a dirty bomb and a nuclear device is huge. If an IND is improperly constructed it may not go nuclear; instead it may detonate and disperse radioactive material in a similar fashion to a RDD.

Characteristics of a Dirty Bomb Incident
Disperses radioactive contaminated dust into the air and onto surfaces. May disperse larger projectiles of either the delivery device (bomb parts) or actual pieces of the radioactive material. Most RDDs will use low-level radioactive materials. Dispersal of radioactive material may be explosive (active, associated with a bomb) or non-explosive (passive, released into a ventilation system or placed in a waste basket). May destroy or damage structures (buildings, infrastructure, utilities, etc). Casualties and damage mainly takes place with initial detonation and the short period thereafter. However low level internal exposures may increase cancer risk. Trainer Notes:

Characteristics of a Dirty Bomb Incident (continued)
May release other hazardous chemicals by damaging nearby chemical storage containers, creating new chemicals in the explosion, etc. Many of the radioactive materials used to make a dirty bomb are also heavy metals which are toxic at low levels. Clean up is difficult and costly. May include a secondary device (RDD or other agent) with intent to harm responders. Trainer Notes:

What is a Secondary Device?
Secondary devices are bombs placed at the scene of an ongoing emergency response. Designed to explode after a primary explosion or other major emergency response event has attracted a large number of responders to the scene, the intent is to inflict injury, damage, and fear among responders. Trainer Notes:

Warning Signs of Possible Explosive Materials or Secondary Devices
Any abandoned container out of place for the surroundings. Obvious devices containing blasting caps, timers, booster charges, etc. Abandoned vehicles not clearly belonging in the immediate environment. Strong chemical odors for which there is no apparent reason. Unusual or foreign devices attached to pressurized containers, bulk storage containers or supply pipes. Trip wires or other booby traps, suspicious mailing containers. Trainer Notes: Bombs can be made to resemble ordinary objects, lunch boxes, paper bags, etc. Second responders working at an explosive incident will have difficulty recognizing out of the ordinary objects. Typically these devices will be hidden in out of view locations, or camouflaged by placing the devices in ordinary objects such as vehicles, flashlights, briefcases, flowerpots, or garbage cans. Usually the devices are detonated by a time delay, although radio-controlled devices or cell phone activated devices could also be used. Guidelines for response from the U.S. Fire Administration: These guidelines recommend that responders: (1) Anticipate the presence of a secondary device at any suspicious incident. (2) Search for a secondary device before moving into the incident area. (3) Avoid touching or moving anything that may conceal an explosive device. (4) Effectively manage the scene with boundaries, exclusion zones, triage areas, etc. (5) Evacuate victims and non-essential personnel as quickly as possible. (6) Preserve the scene as much as possible for evidence collection and crime investigation. Leave all suspicious items alone and report them immediately!

Dirty Bomb (RDD) Radioactivity Basics
Module 2 Dirty Bomb (RDD) Radioactivity Basics Trainer Notes:

Radioactive Hazards: After an RDD Explodes
The dispersion of radioactive material will depend on many factors; primarily the physical form of the radioactive material. The majority of material will likely be dispersed over a large area as radioactive dust. The greatest amount of dust will settle close to the explosion but small amounts can travel large distances, especially small particles. Large pieces of radioactive material can be thrown and emit significant radiation Trainer Notes: Hammer RDD simulation winter 2007

Radioactive Material Defined
Radioactive material is material that is unstable and spontaneously emits radiation. Radioactive material can be dispersed in the form of dust (i.e., from an explosion). This dust will contaminate what it lands on and will contaminate your lungs if you breath it in. Examples of radioactive material: Potassium 40 (found in bananas) Cobalt 57 (a radioactive material that is used in lab experiments) Radon (the radioactive gas that may seep into your basements) Trainer Notes: Radioactive material - Any material that contains radioactive (unstable) atoms. Radioactive materials are everywhere. Usually, we only encounter them in very small amounts. Since radioactive material contains unstable atoms, it emits radiation. Radiation released from radioactive material does not have a smell or taste and cannot be seen.

Examples of Radioactive Materials in Everyday Items
1970’s tape dispenser with thorium sand Bananas with potassium 40 Fiesta Ware with uranium paint Trainer Notes: Lantern mantles with thorium Exit signs with tritium Smoke detectors with americium

RDD Radiation Exposure
Radiation exposure to skilled support workers will come from: radioactive dust large pieces of the bomb’s radioactive materials. Trainer Notes: The following explanations were taken from the CDC Radioactive Contamination and Radiation Exposure Fact Sheet at Radioactive contamination and radiation exposure could occur if radioactive materials are released into the environment as the result of an accident, an event in nature, or an act of terrorism. Such a release could expose people and contaminate their surroundings and personal property. What Radioactive Contamination Is Radioactive contamination occurs when radioactive material is deposited on or in an object or a person. Radioactive materials released into the environment can cause air, water, surfaces, soil, plants, buildings, people, or animals to become contaminated. A contaminated person has radioactive materials on or inside their body. What External Contamination Is External contamination occurs when radioactive material, in the form of dust, powder, or liquid, comes into contact with a person's skin, hair, or clothing. In other words, the contact is external to a person's body. People who are externally contaminated can become internally contaminated if radioactive material gets into their bodies. What Internal Contamination Is Internal contamination occurs when people swallow or breathe in radioactive materials, or when radioactive materials enter the body through an open wound or are absorbed through the skin. Some types of radioactive materials stay in the body and are deposited in different body organs. Other types are eliminated from the body in blood, sweat, urine, and feces. What Radiation Exposure Is Radioactive materials give off a form of energy that travels in waves or particles. This energy is called radiation. When a person is exposed to radiation, the energy penetrates the body. For example, when a person has an x-ray, he or she is exposed to radiation. How Contamination Differs From Exposure A person exposed to radiation is not necessarily contaminated with radioactive material. A person who has been exposed to radiation has had radioactive waves or particles penetrate the body, like having an x-ray. For a person to be contaminated, radioactive material must be on or inside of his or her body. A contaminated person is exposed to radiation released by the radioactive material on or inside the body. An uncontaminated person can be exposed by being too close to radioactive material or a contaminated person, place, or thing. Dust on workers Dust that enters the body Pieces of the bomb

Contamination and Exposure
Contamination takes place when contact is made with radioactive material and it is deposited on the skin, clothing, surfaces, etc. Exposure to radiation occurs when a person or an object is close enough to radioactive material to be affected by it without touching it. Trainer Notes: The following explanations were taken from the CDC Radioactive Contamination and Radiation Exposure Fact Sheet at Radioactive contamination and radiation exposure could occur if radioactive materials are released into the environment as the result of an accident, an event in nature, or an act of terrorism. Such a release could expose people and contaminate their surroundings and personal property. What Radioactive Contamination Is Radioactive contamination occurs when radioactive material is deposited on or in an object or a person. Radioactive materials released into the environment can cause air, water, surfaces, soil, plants, buildings, people, or animals to become contaminated. A contaminated person has radioactive materials on or inside their body. What External Contamination Is External contamination occurs when radioactive material, in the form of dust, powder, or liquid, comes into contact with a person's skin, hair, or clothing. In other words, the contact is external to a person's body. People who are externally contaminated can become internally contaminated if radioactive material gets into their bodies. What Internal Contamination Is Internal contamination occurs when people swallow or breathe in radioactive materials, or when radioactive materials enter the body through an open wound or are absorbed through the skin. Some types of radioactive materials stay in the body and are deposited in different body organs. Other types are eliminated from the body in blood, sweat, urine, and feces. What Radiation Exposure Is Radioactive materials give off a form of energy that travels in waves or particles. This energy is called radiation. When a person is exposed to radiation, the energy penetrates the body. For example, when a person has an x-ray, he or she is exposed to radiation. How Contamination Differs From Exposure A person exposed to radiation is not necessarily contaminated with radioactive material. A person who has been exposed to radiation has had radioactive waves or particles penetrate the body, like having an x-ray. For a person to be contaminated, radioactive material must be on or inside of his or her body. A contaminated person is exposed to radiation released by the radioactive material on or inside the body. An uncontaminated person can be exposed by being too close to radioactive material or a contaminated person, place, or thing. External Contamination Internal Contamination Exposure

Contamination and Exposure (continued)
If radioactive contamination gets onto your clothes, intact skin or surfaces it can be removed through decontamination procedures. (See Module 3.) If radioactive contamination gets into your body through inhalation (lungs), digestive system (through eating or mucus) or goes directly into your blood stream (through a cut) it becomes an internal contamination hazard and may lead to high exposure. Trainer Notes:

What is Radiation? Radiation is energy in motion.
Radiation may be in the form of particles or rays/waves. There are two types of radiation: Non-ionizing radiation Ionizing radiation Trainer Notes: Below are further defined terms used in the slide: Radiation - Radiation is energy in the form of waves or particles given off during radioactive decay, or as a consequence of certain physical processes that we can control. Examples of these are x-ray machines and particle accelerators. Wave radiations include gamma and x-rays. A common term used to describe this type of radiation is photon radiation. Particle radiation can consist of charged or uncharged particles which are emitted with very high velocity. Radiation travels from its source at very high speed, and depending on the type, may be able to penetrate easily through very dense materials. For a dirty bomb response we are most concerned about ionizing radiation

The Radiation Spectrum
Trainer Notes: The presented radiation spectrum was found at The units are µm. Scale = µm

How Can I Protect Myself?
Prevent inhalation or ingestion of radioactive dust or deposition of radioactive dust on skin or a wound. Use the Hierarchy of Controls: Eliminate the hazard (leave the area) Engineer the hazard out (use wet methods to control dust) Administrative (use standard operating procedures (SOPs)) Personal Protective Equipment (PPE) (i.e., respirators) Trainer Notes:

How Can I Protect Myself? (continued)
Avoid areas with radioactive contamination. Decontaminate yourself in accordance with your site decontamination plan. Use radiation detection devices. Time, Distance and Shielding. Note: Time, distance and shielding may not relate to internal radiation hazards. Trainer Notes: Determine whether you are exposed to the dust, pieces of the bomb, or both.

How Can I Protect Myself - Dust
Dust can be both contamination on your skin or contamination breathed or ingested into your body. Ensure that all measures are taken to minimize dust generation (use wet methods, etc.) As a final step, wear the appropriate respirator to avoid inhaling dust and protective outer clothing to prevent skin contamination. After exposure, take all steps to remove dust. Trainer Notes:

How Can I Protect Myself – Bomb Fragments
The detonation of an RDD may produce larger fragments in the form of shrapnel. Larger pieces may have a higher associated radiological hazard than the dust created from an RDD explosion. If you are not certain whether or not a piece of material is radioactive, leave it alone and report it so it can be tested. Do not handle suspect material. Do not remove shrapnel from a wound unless you are medically qualified to do so. The hazard from radiation will probably be less than the hazard of improperly removing shrapnel. Seek medical attention. Trainer Notes:

More on Time Limit your exposure to the radioactive source.
By limiting your time, you limit your dose. Trainer Notes:

More on Distance – STAND BACK!
By increasing the distance between you and the radioactive material you will reduce your dose-rate. In fact, if you double your distance from the source, you will reduce your dose-rate to one/fourth. Trainer Notes: Doubling your distance from the source, reduces your dose-rate by three/fourths. This is called the inverse square law.

More on Shielding Trainer Notes:
Source – U.S. EPA, Ionizing Radiation Fact Book, EPA-402-F , March 2007

Units to Measure Ionizing Radiation
The following are units used to measure radiation dose. These are some of the terms you might hear on site: Rad - Units for absorbed doses of all radiation Roentgen - Units of exposure to gamma radiation Rem (mrem) - Unit of dose related to biological risk Trainer Notes: Rad: An acronym for Radiation Absorbed Dose. Roentgen (R): A unit of exposure to ionizing gamma radiation in air. Rem: An acronym for Roentgen Equivalent Mammal. The unit of dose of any type of ionizing radiation that produces the same biological effect as a unit of absorbed dose of ordinary X-rays. Note: 1000 mrem = 1 rem

Radiation Dose vs. Dose Rate
Radiation Dose (cumulative): The amount of radiation energy deposited in the body Often measured in millirem Dose Rate: The rate at which radiation energy is deposited in the body Often measured in millirem per hour Trainer Notes: Units of Radiation To quantify amounts of radiation, the term rem or millirem is used. It has a specific definition, but we’re concerned with how many rather than a definition. Note: rem = roentgen equivalent man rem = rad X RBE rad = radiation absorbed dose (deposition of 100 ergs of radiation energy per gram of absorbed material) RBE = relative biological effectiveness Other terms you may see or encounter are: Gray (Gy): 1 rad = 1cGy or 1 Gy = 100 rads Sievert (Sv): 1 Sv = 100 rems So again for our purposes, 1 Sv = 1 Gy

Radiation Dose Acute Chronic High dose rate Low dose rate
Short period of exposure Visible signs of exposure Nausea Fatigue Hair loss Burns Very damaging to tissue Cells have less time to repair Immune system damaged Chronic Low dose rate Long period of exposure Less immediately damaging to tissue No immediate visible effects May cause cancer Trainer Notes: Acute radiation doses An acute effect is a physical reaction due to massive cell damage. This damage may be caused by a large radiation dose received in a short period of time. Large doses of radiation received in a short period of time are called acute doses. The body can't repair or replace cells fast enough from an acute dose and physical effects such as reduced blood count and hair loss may occur. Slight blood changes may be seen at acute doses of 10,000-25,000 mrem but an individual would not otherwise be affected. Radiation sickness At acute doses greater than 100,000 mrem, about half of the people would experience nausea (due to damage of the intestinal lining). Radiation therapy patients often receive whole body equivalent doses in this range and above, although doses to the region of a tumor are many times higher than this. If the acute dose to the whole body is very large (on the order of 500,000 mrem or larger) it may cause so much damage that the body cannot recover. An example is the 30 firefighters at Chernobyl who received acute doses in excess of 800,000 mrem. These individuals succumbed to the effects of the burns they received compounded by their radiation dose. After an acute dose, damaged cells will be replaced by new cells and the body will repair itself, although this may take a number of months. Only in those extreme cases, such as with the Chernobyl firefighters, would the dose be so high as to make recovery unlikely. Acute doses to only part of the body It is possible in that radiation exposure may be only to a limited part of the body such as the hands. There have been accidents, particularly with X-ray machines, in which individuals have exposed their fingers to part of the intense radiation beam. In some of these cases individuals have received doses of millions of mrem to their fingers and some individuals have lost their finger or fingers. It is important for individuals who work with x-ray or similar equipment to be trained in the safe use of this equipment. Chronic radiation doses A chronic radiation dose is typically a small amount of radiation received over a long period of time. An example of a chronic dose is the dose we receive from natural background every day of our lives or the dose we receive from occupational exposure. Chronic dose versus acute dose The body is better equipped to handle a chronic dose than an acute dose. The body has time to repair damage because a smaller percentage of the cells need repair at any given time. The body has time to replace dead or non-functioning cells with new healthy cells. It is only when the dose of radiation is high and is received very rapidly that the cellular repair mechanisms are overwhelmed and the cell dies before repair can occur. A chronic dose of radiation does not result in detectable physical changes to the body such as is seen with acute doses. Because of cell repair, even sophisticated analysis of the blood do not reveal any biological effects.

What the Exposure Levels Mean
Health Effect Dose (rem) Temporary sterility in testis 15 Nausea 35 Bone marrow depression 20-50 Reversible skin damage 200 Permanent sterility in ovaries 250 Vomiting, fatigue, moderate bone marrow depression 300 Permanent sterility in testis 350 Lethal dose 450 and up Trainer Notes:

Atomic Structure Atoms consist of: A nucleus (center) made of: Protons (+charge) Neutrons (neutral) Electrons (-charge) orbiting the nucleus. Trainer Notes: For the atom to be stable the number of neutrons must nearly equal the number of protons.

What Makes an Atom Unstable?
An atom’s stability is based on its proton to neutron ratio If there are too many or too few neutrons for the number of protons the atom will give off excess energy in the form of: Particles Rays/waves This process is called radioactive decay (the release of radiation). Trainer Notes: When an atom is unstable it can damage living tissue

Ionizing Radiation The energy given off by the nucleus is called ionizing radiation It is strong enough to detach an electron from an atom. When an atom loses an electron, it has a positive charge and is called an ion. The ion and its lost electron are called an ion pair. Ionizing radiation can damage living tissue. Trainer Notes:

How Does Ionizing Radiation Harm Me?
Destroys cells May produce genetic effects Affects embryo and fetus Increases cancer risk Embryo and fetus cells rapidly divide, making them sensitive to ionizing radiation. Trainer Notes: There are special considerations and regulations when a worker is, may be pregnant or is trying to conceive. Make sure if you have a female student taking this course that they are aware of the issues. If you are pregnant, you and your developing baby are more susceptible to the effects of radiation. If you are pregnant, think you are pregnant or are trying to conceive, consult your physician (or other appropriate professional).

What is Ionization? Ionization occurs when atoms absorb sufficient energy from particle or wave radiation to break their molecular bonds and give off an electron. This causes changes or destruction of molecules. Ionization can damage living tissue. Trainer Notes: Below is a further definition of Ionizing radiation. Ionization - The process of ionization is important in understanding radiation, because it is this process that differentiates ionizing radiation from other types. Ionization is the process of removing electrons from atoms. If enough energy is supplied to remove electrons from the atom the remaining atom has a + charge. The positive charges atom and the negatively charges electron are called an ion pair. Ionization should not be confused with radiation. Ions (or ion pairs) can be the result of radiation exposure and allow the detection of radiation. Typically, we classify types of radiation as ionizing or non -ionizing radiation depending on whether or not the radiation can form ion pairs in common material such as air or tissue. Ionizing radiation - Radiation which has enough energy to ionize an atom is called ionizing radiation. The four basic types of ionizing radiation that are of primary concern for us are alpha particles, beta particles, gamma rays (includes x -rays) and neutron particles. Non-ionizing radiation - Radiation that doesn't have the amount of energy needed to ionize an atom. Examples of non-ionizing radiation are ultraviolet rays, microwaves and visible light.

Radiation Basics Three types of ionizing radiation we are concerned with are: Alpha (α) Beta (β) Gamma (γ) Trainer Notes: Of greatest concern with dirty bombs are alpha and beta radiation emitted from inhaled or ingested radioactive contaminated dust.

Alpha Radiation Internal hazard: do not inhale or ingest.
Not an external hazard. Can cause great biological damage. Particle form. Travels a few centimeters in air. Stopped by a sheet of paper or protective layer of intact skin. Trainer Notes:

Beta Radiation External and internal hazard. Particle form.
Travels feet in air. Shield betas with low density materials such as aluminum or Plexiglas. Trainer Notes:

Gamma Radiation Whole body hazard (internal and external).
Wave type of radiation – non-particulate. Travel many feet in air. Shield with lead or steel. Trainer Notes: Further explanation of X-rays Wave type of radiation - non-particulate Photons originating from the electron cloud Same properties as gamma rays relative to mass, charge, distance traveled, and shielding Characteristic X-rays are generated when electrons fall from higher to lower energy electron shells Discrete energy depending on the shell energy level of the atom Bremsstrahlung X-rays are created when electrons or beta particles slow down in the vicinity of a nucleus Produced in a broad spectrum of energies Reason you shield betas with low density material

Where Does “Every Day” Ionizing Radiation Come From?
Trainer Notes:

Types of Ionizing Radiation (summary)
Type Alpha Beta Gamma Physical Particle Particle Ray, Wave Characteristics Penetrating Very Low Low High Power (Range) (1-2” in air) (10-12” in air (several hundred few mm in skin) feet in air) Shielding 1” in air Aluminum Concrete Outer layer of Glass Lead intact dead skin, Plastic Steel Clothing Safety glasses Earth berm Biological Hazard Internal Internal, Skin, Whole body Eyes, External Trainer Notes:

Exposure Levels for Ionizing Radiation
Response Worker: 5 rems/year for all occupational exposures (OSHA) In addition, the Department of Homeland Security has voluntary guidelines for emergency response: Protective Action Guidelines (PAGs) for RDDs and INDs Trainer Notes: Response Worker exposure levels taken from Department of Homeland Security Protective Action Guidelines (PAGs) for RDDs and INDs. PAGs are not defined as “safe” or “unsafe” levels. These are voluntary guidance limits used in emergencies were developed based on multiple resources. Exposure limits for radiation worker annual dose equivalent limits (10 CFR 20 and 10 CFR 854: 5 rem/year total effective whole body 15 lens of the eye in a calendar year 50 rem organ or skin .5 rem during pregnancy Occupational exposure limits for rems/ calendar quarter (29 CFR ): 1 ¼ for whole body: Head and trunk; active blood-forming organs; lens of eyes; or gonads 18 ¾ for hands and forearms; feet and ankles 7 ½ for skin of whole body At PAG levels, you may have acute (immediate) and chronic (gradual, long-term) health effects. * 10 rems/year for protecting valuable property * 25 rems/year for lifesaving or protection of large populations

What is the Best Practice?
ALARA As Low Reasonably Achievable Trainer Notes: ALARA is a concept that includes reducing both internal and external exposure to ionizing radiation.

What If I Get Internal Radioactive Exposure?
There are some medical treatments available that may be used before you receive, or if you receive a high internal exposure of radiation: Potassium Iodide Neupogen Prussian Blue Diethylenetriaminepentaacetate (DTPA) Trainer Notes: These pharmaceutical treatments are used as “last resort” countermeasures. Emphasis the hierarch of controls when protecting against radiation. Do mention that there may be a medical treatment if all else fails but don’t substitute these for good, sound hazard controls! For further information on the use and effects of these pharmaceutical treatments see the corresponding CDC links below: Potassium Iodide (KI) see Neupogen see Prussion Blue see DTPA see You should see a doctor for these treatments. Some treatments have side effects.

How Do I Know Radiation is Present?
Radiation detection meter Direct reading dosimeters Trainer Notes: Thermoluminescent devices Film badge

Non-Ionizing Radiation
Not a high hazard concern with RDDs Energy in motion that is not strong enough to remove an electron from an atom Examples of non-ionizing radiation are: Visible light Microwaves Infrared UHF/VHF radio waves Trainer Notes: Non-ionizing radiation can be harmful but affects living tissue differently than ionizing radiation.

Controlling hazards during a dirty bomb response
Module 3 Controlling hazards during a dirty bomb response Trainer Notes:

Emergencies in the Field
Ask what first aid support is available during your briefing and be sure you understand where it is located. For minor injuries or health concerns go to: Local hospitals or clinics First Aid, EMT or nurse station For serious emergencies call 911. Know your exact location Notify your supervisor about all injuries and emergencies. Trainer Notes: Before work assignments, understand how emergency services will be contacted (i.e. on site service, cell phone, cb radio, etc.) During a terrorist event, DHS, FBI, etc., may jam cell phone lines. Be aware that you may need to use approved lines of communication to contact your family. OSHA Subpart D contains specific requirements for the provision of first aid, medical attention, and emergency facilities. Additional OSHA requirements: Names of employees to contact for further information Alarm system in compliance with (e) (fire Alarms) or (Emergency Action Plans) Training of sufficient employees to assist in evacuation before program is implemented The plan must be reviewed whenever a change has taken place and upon initial assignment If the employer has 10 or fewer employees, the program can be communicated verbally

National Incident Management System (NIMS)
NIMS is designed to: provide a framework for incident management “One mission, one team...” Used for ALL types of incidents (e.g., mass casualty and planned events). First standardized approach to incident management and response. Establishes uniform set of procedures to be used by emergency responders at all levels of government to conduct response operations. Trainer Notes: NIMS slides developed from material created by University of Massachusetts Lowell/TNEC. NIMS was released in March 2004.

Core Elements of NIMS Incident Command System (ICS)
Preparedness (planning, training, exercises, qualifications and certifications of all personnel involved in incidents) Communications and Information Management Joint Information System National Integration Center, Incident Management Systems Division Trainer Notes:

Incident Command System (ICS)
The incident command system will be used to effectively manage emergency situations. ICS uses: Unity of command (one person in charge) Span of control to manage personnel (3 - 7 people under one supervisor) Common terms so everyone understands what is being said A modular system to manage resources (a system that can expand and contract with the emergency event) Life safety code Trainer Notes: Span of control - 5 is the optimal number of people to have under one supervisor Life safety code is: Protect self Control incident Protect property and environment

Incident Command System Structure
Trainer Notes: The National Incident Management System (NIMS) requires the use of the Incident Command System at domestic emergencies involving multi-jurisdictional participation. Effective coordination (of both personnel and equipment) among local, state, and federal responders at the scene of a response is a key factor in ensuring successful responses to major incidents. An Incident Command System/Unified Command (ICS/UC) is the tool used to manage all emergency response incidents. Understanding the concepts of ICS/UC is as important for local responders, who generally arrive on-scene first and thus are most likely to implement the management system, as it is for state and federal organizations and any skilled support personnel that may be joining the response. ICS is a standardized on-scene incident management concept designed specifically to allow responders to adopt an integrated organizational structure without being hindered by jurisdictional boundaries. An ICS allows integrated communication and planning by establishing a manageable span of control. An ICS divides an emergency response into five manageable functions: Command, Operations, Planning, Logistics, and Finance and Administration. You can find more information on ICS at The following training (and more) is available from FEMA’s Emergency Management Institute: ICS-100, Introduction to ICS; ICS-200, Basic ICS and IS-700: NIMS An Introduction. Information on who must take what training can be found at

Work Zones Exclusion zone (hot zone) - radiation hazard is present and only properly trained and authorized personnel may enter. Contamination reduction zone (warm zone) - used to remove contamination from personnel and equipment and includes: Decontamination corridor Emergency decontamination Support zone (cold zone) - incident command and other support functions stationed here. Trainer Notes: Common HAZWOPER work zones are used in the presentation. Some agencies may use other zone designations which are presented below: Some agencies such as DHS or DOE will use the term “radiation control zones” when dealing with radioactivity. HAZWOPER and Rad-specific training is required for entry into hot and warm zones on an RDD site.

More About Work Zones Setting up work zones will depend on:
Magnitude of ordinance used Radioactive material used Population density Environmental factors: wind direction, day/night, etc. Trainer Notes:

Health and Safety Plans (HASP)
OSHA has set regulations that require Health and Safety Plans (HASP) to protect workers involved in national response operations.* The HASP serves as a guide for employers and workers to follow during their daily operations to prevent the spread of contamination, injury, and death. Trainer Notes: *OSHA, 29 CFR , HAZWOPER

HASP (continued) All HASPs must cover all of the following:
This document covers some HASP sections that will be used on the worksites during a dirty bomb response. The site safety section includes general information from several of the HASP sections listed below. All HASPs must cover all of the following: - Introduction - Key Personnel - Hazard Assessment - Training - PPE - Temperature Extremes - Medical Surveillance - Exposure Monitoring and Air Sampling - Site Control - Decontamination - Emergency Response/ Contingency Plan - Emergency Action Plan - Confined Space Entry - Spill Containment Trainer Notes: Health and safety plans (HASP) should include protocols for responding to terrorist events recognizing the possibility that secondary explosive devices may be used at the scene.

Personal Protective Equipment (PPE)
Depending upon your worksite’s PPE program and assigned job task, any of the following PPE may be required: Protective suit ranging from standard coveralls to a liquid impermeable splash suit with hood to keep contamination out of hair Respirator ranging from an N-95 to a PAPR for high exposure and strenuous work. In rare cases a SCBA may be required (initial response, high levels of heavy metals) Trainer Notes: The OSHA PPE standard (29 CFR 1910 Subpart I) must be followed when selecting and implementing PPE. PPE selection should be based on job task and exposure levels. Before you can wear a respirator you must be medically cleared, fit tested and trained in accordance with the OSHA respiratory protection standard, 29 CFR

PPE (continued) Protective washable or disposable footwear
Inner disposable glove and disposable outer cut/abrasive resistant work glove Fully enclosed goggles Ear protection in noisy areas Head protection if in construction or demolition zones Be sure to follow your worksite’s PPE program Trainer Notes: The OSHA PPE standard (29 CFR 1910 Subpart I) must be followed when selecting and using PPE.

PPE Examples N-95 respirator Safety glasses
Level C PPE with tyvek splash suit and APR respirators ½ face APR Safety Goggles Trainer Notes: Full face APR Example of Leather gloves Courtesy Kirkwood Example of Nitrile gloves Courtesy Kirkwood Face Shield PAPR

Decontamination Within the immediate blast area
Decontamination or Decon is the process of removing, destroying, or reducing the activity of materials such as toxic chemicals or radioactive contamination that could endanger an individual or the environment. Decontamination of personnel is necessary to keep the radiation from spreading to other locations. In the event of a dirty bomb the heaviest contamination will occur: Within the immediate blast area of the detonated device or area of dispersion Handling contaminated people or property near the dispersion Trainer Notes: The following decontamination information is from the Medical Management of Radiological Casualties Handbook 2nd Ed. Military Medical Operations Armed Forces Radiobiology Research Institute Bethesda, Maryland 20889–5603 Removal of outer clothing and rapid washing of exposed skin and hair removes 95% of contamination. The 0.5% hypochlorite solution used for chemicals will also remove radiological contaminants. Care must be taken to not irritate the skin. If the skin becomes erythematous, some radionuclides can be absorbed directly through the skin. Surgical irrigation solutions should be used in liberal amounts in wounds, the abdomen, and the chest. All such solutions should be removed by suction instead of sponging and wiping. Only copious amounts of water, normal saline, or eye solutions are recommended for the eye.

Decontamination (continued)
A decontamination plan should include: Training Location and layout of decontamination stations and areas Decontamination methods Required decontamination equipment Standard Operating Procedures (SOPs) to minimize worker contact with contamination during decontamination SOPs for decontamination line personnel Procedures for collection, storage and disposal of clothing equipment and any other materials that have not been completely decontaminated Procedures to dispose of PPE and decon solutions as contaminated waste Adequate personal washing stations Post-radiation detection station to ensure contamination is removed to acceptable levels Trainer Notes: A Decontamination plan tells workers what methods should be used for decontamination at a worksite.

Decontamination (continued)
Site workers who use the site’s SOPs are less likely to be contaminated than site workers who do not use these practices. Workers can take steps to minimize their exposure during decontamination through using contact minimization techniques such as: Remote handling techniques which reduce hand-to-material contact such as using shovels, wheelbarrows, Bobcats, etc. Avoiding handling sharp debris since external radiation can become an internal hazard through punctured skin. Wearing an outer layer of disposable clothing (PPE). Encasing tools/equipment in plastic (i.e. place sampling equipment in a plastic bag). Trainer Notes:

Decontaminating an Injury
If you have a cut or punctured skin take precautions to prevent radioactive external contamination from becoming a radioactive internal exposure hazard: Seek qualified medical treatment Do not abrade the skin or wound Do not force decon solution into the wound (this will direct radioactive contamination into the body!) Direct decon solution to flow away from the wound by using gravity Trainer Notes: The following decontamination information on decontamination wounds is adopted from the Medical Management of Radiological Casualties Handbook 2nd Ed. Military Medical Operations Armed Forces Radiobiology Research Institute Bethesda, Maryland 20889–5603 Wound Decontamination All casualties entering a medical unit after experiencing a radiological attack are to be considered contaminated unless there is certification of noncontamination. The initial management of a casualty contaminated by radiological agents is to perform all immediate life/limbsaving actions without regard to contamination. Removal of protective clothing (PPE) and other exterior garments during the course of resuscitation will remove nearly all contamination except where the suit has been breached. Initial Decontamination During initial decontamination in the receiving areas, bandages are removed and the wounds are flushed; the bandages are replaced only if bleeding recurs. General Considerations Only highly energetic gamma emitters present any immediate hazard in wound contamination. Local wound contamination is by particulate matter, or possible shrapnel from bomb, that should be removed if possible. Alpha and beta emitters left in the wound will cause extensive local damage and may be absorbed into the systemic circulation and redistributed as internal contaminants. If possible, a radiation detection probe should be carefully placed into the dried wound, without touching any of the wound surfaces. DO NOT CONTAMINATE THE PROBE with radioactive particles, body fluids! Tissue fluids or protective gloves may prevent the detection of alpha and weak beta particles. After determination that adequate decontamination has been obtained, the wound should again be thoroughly irrigated with saline or other physiologic solution. Aggressive surgery such as amputation or extensive exploration should not be undertaken to “eliminate radioactive contamination.” The surgical damage will far exceed any potential decrease in lifetime radiological exposure risk. Partial-thickness burns should be thoroughly irrigated and cleaned with mild solutions to minimize irritation of the burned skin. Blisters should be left closed; open blisters should be irrigated and treated in accordance with appropriate burn protocols. In full-thickness burns, radioactive contaminants will slough in the eschar. As there is no circulation in the burned tissue, contaminants will remain in the layers of dead tissue. Excision of wounds is appropriate when surgically reasonable. Radioactive contaminants will be in the wound surfaces and will be removed with the tissue. Photo from REACTS decon tool

Decontaminating an Injury (continued)
Survey the wound before and after decon has been performed to determine the level of contamination reduction Trainer Notes: Photo from REACTS decon tool For further information on decontaminating a wound go to:

Further Steps to Reduce Radiation Internal Exposure
Do not eat, drink or smoke in a radiation controlled area (warm or hot zone). Only eat, drink or smoke in authorized areas after you have been properly decontaminated. Wash hands and face frequently when not in work areas. While working the incident only eat and drink what is provided there. Trainer Notes:

Prevent the Spread of Radioactive Contamination to Your Family and Home
Bringing home contaminated work clothes or equipment may contaminate your home and place your family at risk. Bring a clean change of clothes to the worksite. Wash work clothes separately. Preferably in a employer provided location. Trainer Notes:

General Safety Tips Be careful and use safety measures outlined in your worksite’s HASP at all times. This is a crime scene; be on the lookout for additional destructive devices. Walking/working surfaces may be wet, slippery and unstable. Spread sand and wear slip resistant footwear if possible, to reduce slips and falls. Trainer Notes:

General Safety Tips (continued)
Walking over and handling debris that is unstable can cause cuts, scrapes, bruises, sprains, etc. Make sure you have had a current tetanus vaccination. Revaccinate for a dirty wound if current vaccination is over 5 years old. If you will be performing direct patient care or otherwise expect to have contact with bodily fluids, get the Hepatitis B vaccine series. Avoid contact with stagnant water. If exposed to stagnant water, wash and decontaminate yourself and any contaminated equipment immediately. Use steel toe/shank non-slip footwear if available. Use durable outer gloves when handling debris. Wear ear protection for noisy environments. Trainer Notes: Key items to have PPE –For information on what equipment you need for protection, contact your local OSHA office or NIOSH Earplugs Sun screen 29 CFR Part 1926 Subpart E Personal Protective and Life Saving Equipment ( to ) See Personal Protective Equipment Fact Sheet, also in Spanish, at -- See Publications: -- OSHA 3077, Personal Protective Equipment -- OSHA 3151, Assessing the Need for Personal Protective Equipment: A Guide for Small Business Employers

Bloodborne Hazards Use latex or similar gloves when handling human remains or assisting those with injuries. Replace gloves if punctured or torn. Do not handle human remains if you have skin cuts or punctures. Use goggles or face shield and mask for handling human remains, recovering deceased. Make sure to cover your nose and mouth. Transport human remains in closed, leak-proof, labeled containers. Remember, remains may be contaminated with radioactive material. Trainer Notes: Use goggles or face shield and mask for handling human remains, recovering deceased. Make sure to cover the nose and mouth to protect the skin of the face and the mucous membranes OSHA Blood Borne Pathogen Standard: 29 CFR

Chemical Hazards and the Hazcom Standard
There may be a release of hazardous chemicals from the detonation device or from a secondary device. The material that forms the dust during an RDD release may also be toxic (i.e. many radioactive materials are also heavy metals). Specific Hazard Communication training is required for any potential chemicals that you may come in contact with. Understand how to locate, read and apply information in Material Safety Data Sheets (MSDS). MSDS provide both workers and emergency personnel with the proper procedures for handling or working with a particular substance. Trainer Notes: Some symptoms of short-term chemical exposure include: irritated tissues (skin, eyes, nose, throat and upper respiratory track), flu-like symptoms, difficulty breathing, fatigue, loss of coordination, mental confusion, sleeplessness, dizziness, chemical burns, asphyxiation, and impaired vision. Long-term symptoms depend on the extent and duration of exposure to the chemical. Refer to the OSHA Hazard Communication Standard 29 CFR for more information on the requirements of hazardous material handling and use.

Carbon Monoxide (CO) Exposure
Carbon Monoxide has no warning properties; it is a colorless odorless gas! Symptoms: Headache, dizziness, drowsiness, or nausea; progressing to vomiting, loss of consciousness. Prolonged or high exposure can lead to coma or death. Worksites that have a high risk for CO exposure include: Any activity using gasoline or propane-powered machinery Near operating equipment Near generators Debris reduction sites Near hot work (cutting, welding) especially in confined spaces Trainer Notes: General Recommendations: Use CO warning sensors when using or working around combustion sources. Shut off engine immediately if symptoms of exposure appear. Warning! Do not use gasoline generators or portable fuel driven tools in confined spaces or poorly ventilated areas. Warning! Do not work in areas near exhaust (CO poisoning occurs even outdoors if engines generate high concentrations of CO and worker is in the area of the exhaust gases). With symptoms of exposure, shut off the engine. OSHA (c) If using a fuel powered tool in an enclosed area such as a trench, be aware that carbon monoxide generated can displace or deplete oxygen. Mechanical ventilation and testing needs to be done. Note: CO poisoning can occur in small spaces, such as a crawl space or large areas, such as a big parking garage.

Excavation Hazards Search and Rescue or structural repair operations may require excavation. Excavations can create many hazards which must be controlled to safely work around and in them. An excavation is any man-made cut, hole, trench, or depression in the earth formed by earth removal. A trench is defined as a narrow below-ground excavation that is deeper than it is wide, and is no wider than 15 feet. Trainer Notes: See OSHA Construction Standard for excavations, 29 CFR 1926, subpart P.

Excavation Hazards (continued)
The following are potential excavation hazards: Cave in Falls; falling loads Hazardous atmosphere Incidents involving mobile equipment A competent person must evaluate soil for excavation safety. All excavations/trenches should have safe means for entering and exiting (ladders, safe design, etc.). DO NOT enter an unsafe excavation! Trainer Notes:

Excavation Hazards (continued)
If an excavation is over 4 feet deep, an egress (emergency exit route/device i.e. ladder) must be provided which may not be the sides of the excavation. Distance to egress must be 25 feet or less. If an excavation is five feet deep or more, one of the following engineering controls must be used: Shoring Shielding Sloping Movement of overloaded or unusual vehicles, oversized loads, and heavy operating equipment Trainer Notes: OSHA 29 CFR 1926 Subpart P See OSHA’s Trenching and Excavation Factsheet

Controlling Excavation Hazards
Sloping in type C soil Shielding Trainer Notes: Shoring

Excavation Hazards (continued)1
General Trenching and Excavation Rules Keep heavy equipment away from trench edges. Keep surcharge loads at least 2 feet (0.6 meters) from trench edges. Know where underground utilities are located. Test for low oxygen, hazardous fumes and toxic gases. Inspect trenches at the start of each shift. Inspect trenches following a rainstorm. Do not work under raised loads. 1. OSHA Trenching and Excavation Factsheet Trainer Notes: Surcharge loads are additional loads nearby the excavation site, such as soil from the excavation and equipment. In some instances, the design of vertical walls of the excavation will be affected by wheel loads or other surcharge loads on the ground surface. These loads should be considered in the structural stability calculations and in the detailed design as appropriate. They should be based on the heaviest piece of equipment likely to be placed on the fill during construction.1 1US Army Corps of Engineers: Planning and Design of Navigation Dams Manual

Your Safety Officer Must Approve Confined Space Entry!
Confined Spaces What is a Confined Space? Space with limited access Large enough for bodily entry Not designed for occupancy Example: sewers/storm drains What are the hazards? Oxygen deficiency Entrapment Engulfment Hazardous atmosphere Trainer Notes: Confined Spaces may only be entered by Authorized Personnel approved by the Safety Officer OSHA 29 CFR Notice the retrieval tripod being used to access the confined space. The task being performed is sumping the sewer system. Possible hazards: Hydrogen Sulfide, Methane, Entrapment, Environmental hazards such as rodents, snakes, & insects. Work involving confined space entry shall conform to 29 CFR Any agency or contractor that will be performing confined space entry shall develop a specific plan and conduct a JHA prior to commencing work. Plans shall include space evaluation and established acceptable entry conditions; a permit system; training for entrants, attendants, and supervisors; atmospheric monitoring; and rescue / emergency services. The detonation of an RDD may cause massive structural damage, depending on the charge. Structural collapse may create confined spaces. Make sure workers understand that confined spaces, especially unstable ones, are deadly and may only be entered with proper training, equipment and planning. Your Safety Officer Must Approve Confined Space Entry!

Confined Spaces (continued)
Before you enter a confined space your supervisor must: Make sure you and the attendant are trained. Ventilate and monitor for hazardous atmosphere. Lock out or tag out all power equipment in the space. Issue appropriate PPE, possibly including self-contained breathing apparatus (SCBA). Establish barriers to external traffic such as vehicles and pedestrians. Provide ladders or similar equipment for safe entry and exit in the space. Provide good communications equipment and alarm systems. Have rescue equipment and trained rescue personnel nearby. Trainer Notes: Per OSHA 29 CFR

Structural Integrity OSHA requires walls or floor to be shored or
braced before demolition if workers are within structure. Cut off, cap or control all service utility lines outside the building before demolition work is started. Notify appropriate utility company in advance. If it is necessary to maintain any utilities during demolition, such lines shall be temporarily relocated and protected. Determine if any hazardous substances have been on the property. Remove any found hazardous substance before demolition. Do not cut or remove any structural or load-supporting members on any floor until all stories above such a floor have been demolished and removed. Trainer Notes:

Flying Debris and Material Handling
Wear personal protective equipment, including hard hats, safety shoes, eye glasses, and work gloves. Do not walk under or through areas where cranes and other heavy equipment are being used to lift objects. Make sure that you have an up-to-date tetanus immunization. Trainer Notes:

Debris Piles and Unstable Surfaces
Only walk on surfaces you know are stable. Use other ways to get to work surfaces, such as bucket trucks. Erect scaffolding and park lift equipment on stable surfaces and anchor it to stable structures. Wear protective equipment provided, including safety shoes with slip resistant soles. Use fall protection with lifelines tied off to suitable anchorage points, including bucket trucks, whenever possible. Trainer Notes:

Aerial Lifts Vehicle-mounted devices used to get a worker to an elevated position, (also called “cherry pickers” or “boom trucks”). Only trained and authorized people may operate the lift. Read and understand the safety and operating instructions including all warning decals or labels. Check for overhead objects before use. Stay far from debris piles, drop-offs, and floor openings. Never use near electric lines unless they are deenergized or adequate clearance is maintained. Refuel tanks only when the unit is off and charge batteries in a well ventilated area away from open flames. Elevate the lift only when it is on a firm and level surface. Whenever working out of an aerial, a full body harness must be worn and properly attached to the basket. Never drive the aerial lift when it is elevated above the limit the manufacturer considers safe. Trainer Notes:

Falls from Heights Six Feet and Higher
Employees shall be protected from falls greater than six feet to a lower level. Guardrail Systems Safety Net Systems Fall Arrest Systems (less effective than guardrail and safety net systems) Cover or guard any openings or floor holes as soon as they are created. Make sure floor hole covers support two times the weight of employees, equipment, and materials Be careful when stepping into areas that are unstable/uneven or where the surface cannot be visualized (i.e., areas covered by water). Workers should prevent items from falling onto people below. Trainer Notes:

Ladder Safety Ladders can create a falling hazard. Make sure your ladder is secure: Position portable ladders so the side rails extend at least 3 feet above the landing. Secure side rails at the top to a rigid support and use a grab device when 3 foot extension is not possible. Do not apply more weight on the ladder than it is designed to support and make sure that the weight on the ladder will not cause it to slip off its support. Before each use, inspect ladders for cracked, broken, or defective parts. Use only ladders that comply with OSHA standards. Trainer Notes:

Electrical Hazards Electrocution is a common safety hazard on many worksites. Avoid working with electricity in wet environments. If this must be done, use electrical cords approved for wet conditions. Electrical cords and plugs must meet OSHA standards. Use double insulated tools. Check the Underwriter’s Label to be sure the tool is double insulated. Use Ground Fault Circuit Interrupters (GFCIs) on all power tools and cords as close to the panel as possible. Trainer Notes: Treat all power lines and cables as energized until proven otherwise. Workers most at risk are removing debris from roadsides and in the process of pruning trees. When an electrical shock enters the body it may produce different types of injuries. Electrocution results in internal and external injury to body parts or the entire body – often resulting in death. After receiving a “jolt” of electricity all or part of the body may be temporarily paralyzed and this may cause loss of grip or stability. A person may also involuntarily move as a result of receiving an electrical shock, resulting in a fall. Internal or external burns may result from contact with electricity. Electricity travels in closed circuits, and its normal route is through a conductor. Electric shock occurs when the body becomes a part of the circuit. Grounding is a physical connection to the earth, which is at zero volts. The metal parts of electric tools and machines may become energized if there is a break in the insulation of the tool or machine wiring. A worker using these tools and machines is made less vulnerable to electric shock when there is a low-resistance path from the metallic case of the tool or machine to the ground. This is done through the use of an equipment grounding conductor—a low-resistance wire that causes the unwanted current to pass directly to the ground, thereby greatly reducing the amount of current passing through the body of the person in contact with the tool or machine. OSHA 1926 Subpart K ‑ Electrical , Employees must not work near any part of an electric power circuit that the employee could contact in the course of work, unless the employee is protected against electric shock by de-energizing the circuit and grounding it or by guarding it effectively by insulation or other means. * In work areas where the exact location of underground electric power lines is unknown, employees using jack‑hammers, bars, or other hand tools which may contact a line shall be provided with insulated protective gloves. * Before work is begun, inquire or observe by instruments whether any part of an energized electric power circuit is so located that the performance of the work may bring any person, tool, or machine into physical or electrical contact with the electric power circuit. Post and maintain proper warning signs where such a circuit exists. The employer shall advise employees of the location of such lines, the hazards involved, and the protective measures to be taken.

Electrical, Overhead Power Lines, Downed Electrical Wires, Cables
Treat all power lines and cables as energized until proven otherwise. Use appropriately grounded low-voltage equipment. Stay clear of downed electrical lines. Trainer Notes:

Hazardous Utilities Look for overhead power lines and buried power line indicators. Post warning signs. Contact utilities for buried power line locations. Stay at least 10 feet away from overhead power lines. Unless you know otherwise, assume that overhead lines are energized. Get the owner or operator of the lines to de-energize and ground lines when working near them. Other protective measures include guarding or insulating the lines. Use non-conductive wood or fiberglass ladders when working near power lines. Trainer Notes:

Driving and Traffic Issues
Worksites must be posted with legible traffic signs at points of hazard. Flag persons or Flaggers are used when signs, signals, and barricades do not provide adequate protection for workers. Traffic issues workers may experience include: Heavy traffic Inexperienced or poor drivers Trainer Notes: Worker transportation to the jobsite and around the jobsite present safety hazards that can be reduced through proper planning. Workers who drive in the course of their duties shall possess valid licenses appropriate for the vehicles they are driving (including a commercial driver’s license, if required). Drivers shall comply with all applicable traffic safety regulations. Employers shall ensure compliance with state laws governing the use of seat belts. Vehicles should be equipped with a sufficient number of seats for each passenger. Extra care should be exercised when driving on roads that may have been damaged by the hurricane. Roads may be washed out, undermined, or impassable. If possible, avoid driving into standing water due to the potential for unseen hazards. Be alert for debris and down power lines. Traffic may be heavy, especially around checkpoints. Traffic signs may be knocked down or not visible, and traffic signal lights may be inoperative. Street signs and landmarks may not be available. Allow extra time when traveling and drive defensively. Sufficient parking areas should be arranged for workers in a location convenient to where they report for work. Parking areas shall be adequately lit and graded.Traffic issues include: movement of unusual vehicles; oversized loads such as mobile homes, heavy operating equipment. Be prepared for delays. Watch for other drivers Flaggers may be hidden or obstructed by larger vehicles Hazards Congestion Multiple entrances/exits to roadway Power lines Uncontrolled grapples with debris Worker with multiple tasks – flagging & truck loading No signage entering the zone 2 way traffic Limited Visibility for traffic Traffic signs Construction areas shall be posted with legible traffic signs at points of hazard. All traffic control signs or devices used for protection of construction workmen shall conform to American National Standards Institute D , Manual on Uniform Traffic Control Devices for Streets and Highways. Flagmen (persons) Used when signs, signals, and barricades do not provide adequate protection to the worker. Signaling directions must conform to ANSI D Flagman must wear red or orange reflectorized warning garments. Barricades OSHA 29 CFR For employee protection must conform to applicable portions of ANSI D

Heavy Equipment Use OSHA requires machinery to be inspected by a qualified worker before each use. Be alert to the activities around you. Do not exceed the load capacity of lifting equipment. Do not walk under or through areas where heavy equipment are lifting objects. Do not climb onto or ride loads being lifted or moved. Do not ride on equipment or in bucket. Trainer Notes: OSHA requires machinery to be inspected by a qualified worker before each use. Operate equipment correctly and safely. Special Notes for Bobcats: Bobcats are a small, common piece of front-end-loading equipment. In many cases, for clean up of a contaminated avian flu zone, bobcats would be a logical choice to perform much of the assisted material handling. Below are special precautions related to the safe operation of bobcats. A bobcat is a one person machine, no riding in bucket or on machine. Operate at a ground speed consistant with working conditions and terrain. Avoid crossing exposed railroad tracks, ditches, ridges or curbs if possible. If crossing cannot be avoided, reduce speed and cross at an angle. Only qualified people are to operate a bobcat. Handled improperly, this machine could cause severe injury or fatality. Don’t let the small size of the machine fool you! NEVER move or swing loads above the heads of other workers. Avoid slopes with steep or unstable surfaces, do not drive across slopes. Go directly up and down a slope or ramp with the heavy end of the machine uphill. When operating the bobcat, always carry the bucket low or maximum visibility and stability. Be sure operators vision is not obstructed when traveling or working. Never attempt to make sharp turns or travel on steep slopes with a raised load. Extreme caution is required when back filling, as the weight of the loader could cause new construction to fail. When under-cutting high banks, watch for dangers such as falling rocks, overhanging trees or a cave-in.

Heavy Equipment Use (continued)
The following are the types of heavy equipment that may be used during a dirty bomb response: Front End Loaders Forklifts Bobcats Tractors Cranes Trailers Articulated Trucks Trainer Notes: Congestion of heavy equipment and debris. Applicable OSHA Standard (a)(5) The employer shall designate a competent person who shall inspect all machinery and equipment prior to each use, and during use, to make sure it is in safe operating condition. Any deficiencies shall be repaired, or defective parts replaced, before continued use. (a)(6) A thorough, annual inspection of the hoisting machinery shall be made by a competent person, or by a government or private agency recognized by the U.S. Department of Labor. The employer shall maintain a record of the dates and results of inspections for each hoisting machine and piece of equipment. Competent Person (f) defines competent person as one who is capable of identifying existing and predictable hazards in the surroundings or working conditions which are unsanitary, hazardous, or dangerous to employees, and who has authorization to take prompt corrective measures to eliminate them. The OSHA construction standards do not require employees performing crane inspections to have a Level II rating, which is a term used in an ANSI standard not referenced in the OSHA standards.

Debris Removal Equipment
Hazards include: Overhead power lines Traffic Congested – bottle neck area Worker on top of potentially unstable load Modified trailer used to haul oversized load debris No traffic control (direction) Trainer Notes:

Hand and Portable Power Tools
All workers should be trained on the tools they use. Hand Tools Inspect tools in accordance with manufacturers specifications. Take damaged tools out of service. Use only sharp tools. Portable Power Tools Inspect tools in accordance with manufacturers specifications. Use with sharp blades Use with GFCI Use with proper gauge electric cord Use double insulated tools. Always wear eye protection Trainer Notes: OSHA Hand and Power Tool Standard: 29 CFR 1926 Subpart I and 29 CFR 1910 Subpart P

Heat Stress Common signs and symptoms workers experience if they have any of these conditions. Heat Stress Headache Thirst Profuse sweating Muscle aches Heat Exhaustion Dizziness Confusion Nausea Sweating-pale, clammy skin Cramps, legs & abdomen Rapid, weakening pulse & breathing Heat Stroke Restlessness Hot, flushed dry skin Body temp above 104°F Unresponsive/disoriented Trainer Notes: Heat stress hazards are addressed in specific standards for general industry. This page highlights OSHA standards, federal registers (rules, proposed rules, and notices), and standard interpretations (official letters of interpretation of the standards) related to heat stress. Section 5(a)(1) of the OSH Act, often referred to as the General Duty Clause, requires employers to "furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees". Section 5(a)(2)requires employers to "comply with occupational safety and health standards promulgated under this Act".

Heat Stress (continued)
Drink when thirsty. Know the signs of heat-related illnesses. Monitor yourself and coworkers, use the buddy-system. Block out direct sun or other heat sources. Use cooling fans/air-conditioning and rest regularly. Wear lightweight, light-colored, loose-fitting clothes and a hat if available. Avoid alcohol, caffeinated drinks, or heavy meals. Get medical help for symptoms such as altered vital signs, confusion, profuse sweating, excessive fatigue, or rapid heartbeat. Take shelter in shaded areas. Fire fighters should unbutton and remove bunker gear. Trainer Notes:

Noise Exposure Wear appropriate hearing protection in noisy work environments. Examples: power saws, earth-moving equipment, pneumatic tools. A worksite is considered noisy if you have to shout to be heard within three feet. Ear plugs Ear plugs Trainer Notes: OSHA and Employee exposure to excessive noise depends upon several factors: How loud is the noise? Do you have to raise your voice to be heard 3 feet away? What is the duration of each employee’s exposure to noise? Do employees move between separate work areas with different noise levels? Is noise generated from one source or multiple sources? Hearing protection: Earplugs, earmuffs, or a combination, should be used when employees are exposed to high levels of ambient noise. Reference OSHA 29 CFR Ear muffs

Traumatic Stress A traumatic event is a shocking and emotionally overwhelming situation in which an individual perceives actual or threatened death or serious injury. Workers responding to a dirty bomb incident may experience traumatic stress. Reactions to traumatic events will vary, ranging from relatively mild to severe. It is very common for people to experience anxiety, terror, shock, and upset, as well as emotional numbness and personal or social disconnection.1 Pay attention to co-workers and how they are being affected by traumatic stress Trainer Notes: 1 International Society For Traumatic Stress Studies

Traumatic Stress (continued)
Symptoms and negative effects of Traumatic Stress include: Physical illness (headaches, fatigue) Inability to function normally on the job Depression Anxiety Making efforts to avoid reminders of a traumatic event Marital and family conflict Hostility and aggression Death through suicide as a reaction to overwhelming stress Trainer Notes: Note for CH: Need to include information on where to get help if you have these symptoms or see workers with these symptoms.

How to Cope With Traumatic Stress
Some useful techniques to reduce stress when participating in a response are: Take a break from the news Pace yourself and take frequent rest breaks Watch out for each other Be conscious of those around you; responders who are exhausted, feeling stressed, or even temporarily distracted may place themselves and others at risk Maintain as normal a schedule as possible Drink plenty of fluids such as water and juices Trainer Notes: See American Psychological Association help center at apahelpcenter.org and the Center for Disease Control at CDC.gov for further assistance on dealing with post traumatic stress disorder. Individuals with prolonged traumatic stress (anxiety, depression, etc.) that disrupt their daily functioning should consult with a trained and experienced mental health professional.

How to Cope With Traumatic Stress (continued)
Try to eat a variety of foods and increase your intake of complex carbohydrates (breads, muffins made with whole grains) Whenever possible, take breaks away from the work area; eat and drink in the cleanest area possible Recognize and accept what you cannot change-the chain of command, organizational structure, waiting, equipment failures, etc. Talk to people when YOU feel like it; you decide when you want to discuss your experience If your employer provides you with formal mental health support, use it Give yourself permission to feel rotten; you are in a difficult situation Recurring thoughts, dreams, or flashbacks are normal-do not try to fight them; they will decrease over time. Communicate with your loved ones at home as frequently as possible Trainer Notes: Talking about an event may be reliving it.

How to Cope With Traumatic Stress – What You can Do at Home
Reach out - people really do care. Reconnect with family, spiritual, and community supports. Consider keeping a journal. Do not make any big life decisions. Make as many daily decisions as possible to give yourself a feeling of control over your life. Spend time with others or alone doing things you enjoy to refresh and recharge yourself. Be aware that you may feel particularly fearful for your family; this is normal and will pass in time. Remember that ”getting back to normal” takes time. Gradually work back into your routine. Let others carry more weight for a while at home and at work. Trainer Notes:

How to Cope With Traumatic Stress – What You can do at Home (continued)
Be aware that recovery is not a straight path but a matter of two steps forward and one back. You will make progress. Appreciate a sense of humor in yourself and others. It is OK to laugh again. Your family will experience the disaster along with you. You need to support each other. This is a time for patience, understanding, and communication. Avoid overuse of drugs or alcohol. You do not need to complicate your situation with a substance abuse problem. Get plenty of rest and normal exercise. Eat well balanced, regular meals. Trainer Notes:

Protecting Your Family During an RDD Event
Create an emergency response preparedness kit containing: Water Non-perishable food (at least three days worth) First aid supplies Medications Battery powered radio Flashlight Tools Duct Tape Cash/traveler’s checks Clothing Bedding Toiletry items Special needs items Important documents (i.e. birth certificate, passport, etc.) Trainer Notes: As presented in the Laborers-AGC Education and Training fund’s Basic Emergency Response Awareness Module 2: Emergency Preparedness, other action items to workers can do to help prepare their families for a disaster: Purchase a National Oceanic and Atmospheric Administration (NOAA) “All Hazards” Radio for emergency alerts • Post emergency telephone numbers by phone (fire, police, ambulance, etc.) • Teach children how and when to call 9-1-1 • Show each family member how and when to turn off the utilities (water, gas, and electricity) • Train each family member on how to use the fire extinguisher (ABC type), and show the where it’s kept • Install smoke detectors on each level of your home, especially near bedrooms • Stock emergency supplies and assemble a disaster supplies kit Take a first aid and CPR class. Determine the best escape routes from your home. Find two ways out of each room. Find the safe places in your home for each type of disaster. • Practice and maintain your plan • Quiz your kids every six months on emergency preparedness • Conduct fire and emergency evacuations Replace stored water and stored food every six months Test and recharge your fire extinguisher(s) according to manufacturer’s instructions Test your smoke detectors monthly and change the batteries at least once per year When disaster threatens, listen to local radio and television reports for evacuation orders or other important information.

Dirty Bomb Activity If possible, conduct table top or group activities to enhance learning and training experience. Activity can vary in time depending on training objectives, class size, class experience, etc. Make activity “real word” and specific to audience. Trainer Notes: Hammer Rad worker training

Summary Proper training is a key component of a safe response.
Radioactive contamination (dust) is the main hazard. The hazards and issues covered in this training tool are dynamic and require vigilance and flexibility. The key to a safe response is attention to the safety issues of your work environment. In addition to the similar physical hazards of a construction or demolition site, there is the added factor of radiological contamination, threat of secondary devices and potential release of hazardous chemicals. Trainer Notes: All workers must adhere to the following work rules: Follow their employer’s safety & health policies at all times. Follow supervisors’ instructions and adhere to the chain of command. Follow personnel accountability instructions; check-in and check-out. Obtain vaccinations in conformance with the employer’s medical direction. Promptly report all injuries, accidents, and near misses. Seek medical attention as needed. Report all unsafe conditions. Do not perform tasks until proper safety & health controls have been put into place. Employees may refuse to perform tasks that expose them to an imminent danger. Wear all personal protective equipment (PPE) needed for the task. Maintain constant awareness of your surroundings.

Information Sources This training tool is based on recommendations from: U.S. Department of Homeland Security (DHS) Department of Energy (DOE) National Institute for Environmental Health Sciences (NIEHS) National Council on Radiation Protection and Measurements (NCRP) National Institute for Occupational Safety and Health (NIOSH) Occupational Safety and Health Administration (OSHA) Center for Disease Control and Prevention (CDC) Environmental Protection Agency (EPA) International Atomic Energy Agency (IAEA) Factsheets from these agencies and other RDD preparedness resources are available on the NIEHS National Clearinghouse for Worker Safety and Health Training website, Trainer Notes All agency and contractor personnel engaged in response operations must be trained to recognize and avoid hazards. This training is composed of several elements: General training for disaster site workers Site-specific training Task specific training, including any mandated training requirements Pre-deployment and pre-job briefings Site-specific training includes an overview of conditions specific to the locales where the employee will be deployed. Task-specific training includes items such as hazard communication, PPE, use of tools, safety at elevations, etc. Training that is mandated by various agencies, such as OSHA, EPA, USCG, DOT, etc., shall be provided in accordance with those agencies’ guidelines. Pre-deployment and pre-job briefings are conducted on a daily basis by the worker’s immediate supervisor to cover the day’s work plan. Employers (agencies and contractors) shall maintain records of employee training available for inspection by agencies having jurisdiction. Training records include documentation such as, but not limited to, training certificates, attendance rosters, course curriculum matrices, etc. Employers shall provide competent and qualified persons as required by various standards.

Why This Training Tool Was Created
This training tool was created by the NIEHS National Clearinghouse for Worker Safety and Health Training under contract no C-0017 from the National Institute for Environmental Health Sciences Worker Education and Training Program (WETP). WETP has trained over a million emergency responders and hazardous waste workers since 1987 to do their jobs safely. WETP is a part of the Department of Health and Human Services, which is a cooperating agency under the Worker Safety and Health Support Annex of the National Response Plan. As part of the coordinated effort, WETP created this training tool for those who may be involved in a response to an RDD. Trainer Notes:

Protecting Yourself During a Dirty Bomb Response

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