Transcript Monitoring the Public for Radiation

Monitoring the
Public for Radiation
Gregg D. Dempsey
Senior Science Advisor
Radiation and Indoor Environments
National Laboratory
April 14, 2004
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.
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.
Good Information is Vital
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.
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.
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.
• 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.
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
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
From a Brazilian Presentation on
Goiania
Old Clinic
Population monitoring
Police Official being monitored
Mobile radiation monitoring: NaI and
GM detectors mounted on a car
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)
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.
Case Study: Chernobyl, Ukraine
Been there – done that.
Inside the Chernobyl Control Room.
Pripyat, Ukraine
An abandoned city
Chernobyl, Unit 4
The Sarcophagus
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.
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.
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.
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.
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:
Contamination is bad.
Contaminated?
DECONTAMINATE!
WHY?
“Contamination is bad.”
“We have to reduce a
potential health effect.”
“We were trained
that way.”
Will there be a
health effect?
???
Population Monitoring and
Decontamination Problems
How many people do I
have to help monitor?
How many people
are there?
How many survey
instruments do I have?
Are decon supplies
adequate?
*#!?@
Are the survey instruments
the right type?
Do I have a decontamination
facility or can I set one up?
HELP!
Who can do the
Registry stuff?
Do I have clothing for
the contaminated?
The Biggest Problem:
I’ve got more people than
I can possibly handle
and I don’t have enough help.
NO
Is the person
contaminated??
Get Name/Give Info.
Shelter or Home
Shelter/Home
Outta My Hands...
Is the person
YES
contaminated?
Would leaving
contamination in
place cause a health
effect?
NO
Advise
“self decon”
at home
Name/Registry Stuff
Shelter/Home
YES
Is the person
contaminated?
YES
YES
Does hand and foot decon
remove 85% of contamination?
Advise
“self decon”
at home
Name/Registry Stuff
Shelter/Home
Would leaving
contamination in
place cause a health
effect?
YES
Is the person
contaminated?
YES
Does hand and foot decon
remove 85% of contamination?
Would leaving
contamination in
place cause a health
effect?
NO
Semi-supervised “self-decon”
(shower or wipe)
NO
Contamination
gone or sign.
lessened?
Shelter/Home
Yes
Name/Registry Stuff
NO
YES
Is the person
contaminated?
Get Name/Give Info.
YES
YES
Does hand and foot decon
remove 85% of contamination?
Would leaving
contamination in
place cause a health
effect?
NO
NO
Advise
“self decon”
at home
Supervised “self-decon”
NO
Name/Registry Stuff
Advise
“self decon”
at home
Contamination
gone or sign.
lessened?
Shelter/Home
Yes
Name/Registry Stuff
The goal is to get as many people
through monitoring as fast as we
possibly can.
And we’re going to remove anyone
from our monitoring line that might
slow it down or might need special
assistance.
And in this process, we’re going to
identify those that really really need
our help.
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
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
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
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” – http://www.carers.uk.org
• Recruit caregivers or other volunteers as you can.
They can even be neighbors or friends.
• Watch for stress-related problems.
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)
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.
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…)
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…
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.
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?
If your monitoring is this smooth…
Try not to overwhelm a victim with
monitors
Monitoring Techniques
• Use the same radiation monitoring
techniques you’ve been taught with handheld survey equipment.
• Explain what you’re doing and leave the
speaker OFF.
• Answer questions but keep the line
moving.
Certain groups for religious or cultural
reasons may not want to participate in
monitoring or decon. What then?
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.
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.
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 remonitor. 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.
Not Recommended
• Ladder trucks and fogger nozzles
• Cold tap or hydrant water
• Showering in clothing
• Responders scrubbing down the public
Not Recommended
While this might be fine for your own crews,
don’t do this with the general public.
Not Recommended
Avoid any recreation of the “shower scene” from
the movie Silkwood - no aggressive scrubbing!
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.
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
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.
Self-Decontamination
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.
Clothing Issues
• If someone is contaminated and we remove
their contaminated clothing, we have to reclothe 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.
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
Scrub Suit Colors Available
From One Manufacturer
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.
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.
We need more supplies, food,
clothing, towels, and in a hurry!
Guess what this is…
Retail Power in the United States*
• Wal-Mart
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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
Grocery Chains*
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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
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
What Can They Supply?
•
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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”
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Plastic chairs
Sandals/Flip-Flops
Blankets, towels
Clothing items
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.
Where can I get plastic,
visquene, rubber mats, privacy
barriers, etc.?
Ok, guess who this is…
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.
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.
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.
Dealing With Automobiles
Dealing With Automobiles
Correct – just don’t recycle the water.
Dealing With Automobiles
Incorrect.
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.
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.