Radiological preparedness for EMS

[CivilDefense2002]

Did a search and it doesn't seem this has been discussed before - if it has, my apologies for weak search-fu. I'm just curious how radiological preparedness is handled in other areas.

Being both a paramedic and interning with the state civil defense cal lab has given me a unique perspective. I can tell you the state of FL is one of the most prepared states in the country, but there's still a lot of problems. The civil defense instrument program in the Div. of Emergency Management was almost killed in 1996 when FEMA cut funding, but the Dept. of Health picked it up. Unfortunately, the only funding source is the nuclear utilities, so all of the counties not in the EPZ for a power plant are mostly out of luck.

Add onto this the fact almost all agencies - police, fire, or EMS - are very apathetic about the possibility. Police and EMS will generally say it's fire's job, yet PD is generally on scene first (blue canaries, I'm told), and EMS has to transport contaminated patients. The fire guys then say it's the hazmat team's job. Bottom line is nobody's going to know what to do when they pull up to the burning semi-truck with a trifoil on the side. Let alone be ready to handle contamination monitoring on thousands of evacuees from a power plant accident. Don't even go there with the WMD issue...

Training is available from the state, but few seem to take advantage of it. Most fire departments seem to be barely interested in awareness-level stuff for their guys, let alone getting anybody who's going to use instruments through the bare-bones 16-hour G-346 "Fundamentals Course for Radiological Monitoring" class. Those that are lucky enough to have instruments seem to have this idea that it's just "turn them on and they work, right?" Somehow they're then expecting that everyone will somehow magically know to use to the gear when they time comes. It's like saying somebody's qualified to use a LP12 on some kind of inherant knowledge. :roll: G-346, now the highest level anyone off a hazmat team gets, was originally the first step in a series of three classes up to the level of Radiological Officer, FEMA killed the upper level classes due to the fact they couldn't get anyone into the first level in the first place.

Instruments are also a mess. Instrument kits keep coming back that were due for calibration years ago. I checked in with the county OEM I help out last week, and they didn't have a single calibrated CD V-777-1 kit in its inventory of 30 kits. :shock: I was able to get the kits in their EOC exchanged, but all the kits that were deployed with the fire dept's were due for calibration a full year ago. Often kits seem to have been left outside in the rain, smell like they've been soaked in diesel, or had their contents looted. Worst thing is all the instruments where people left the batteries in and filled the case with acid... Some counties and departments are buying their own stuff, but that's few and far between. Most have generally purchased well, but I've heard horror stories from other states...

How is it in your area?

1. Do you have instruments? If so, are they on a calibration schedule?

2. Is your state still active with a Radiological Instrument Maintenence and Calibration facility?

3. Does your state make training available? If so, does anyone go?

4. Does police and EMS involve itself in radiological preparedness, or is it only fire?

5. Are there procedures for handling radiological emergencies and contaminated patients? Has it been agreed where contaminated patients will be transported to?

CivilDefense2002

[somedic]

Your findings are not suprising. Here is the reality of EMS and Radiological preparation:

Unless anyone sees a mushroom cloud, EMS responders will respond into danger areas (hot zones) unknowingly and handle any medical complaints just like they do every day. We are the modern day canaries. The second and third wave of responders can assess the incident by the number of bodies lying in a hot zone wearing a star of life patch.

Most EMS systems have little to no training in what to do at a dirty bomb or other less dramatic radiological incident and as I have seen in most departments in my area....no one cares to learn about Haz-Mat/Radiological response because its not glamourous like "tactical medicine" or riding in a helicopter.

[Medic2588]

CivilDefense,

A lot of your questions may be construed as information that should not be made this public. However, I will say in general for NJ:

1. Radiological detection equipment is available on several EMS units (note several, not 100%). Is it calibrated? Can't say with any degree of certainty, but I know mine is

2. Is the state active in the Maintence program? Not sure if it is active with the same program of which you speak, but our State Police Hazmat Response Unit will assist with maintenance and calibration... or so I'm told.

3. Does your state make training available? Yes, at least twice a year we have training through Bechtel, NV at the Middlesex County Fire Academy. Who goes? Not sure, but I know several EMS persons who have.

4. Do police and EMS involve themselve in Rad/Nuke prep? On the whole yes, especially now that we have the NJ EMS Task Force to be involved in most emergency planning.

5. Plans/protocols for contaminated patients... on the whole yes, but has it filtered through to everyone? Can't be sure. Most every hospital is equipped to decon radiation patients and our state Burn Center can coordinate evacuations to other specialty care centers through the NDMS network.

Devin

[Just Plain Ruff]

Being the cynic, I think that a radiological incident is one of the incidents we are least prepared for and as a result the majority of those responding will be either very very sick or they will die.

I know of few ems agencies who have any type of gear to respond to an incident. Protective clothing and monitoring equipment I have never seen.

Dirty bombs are foreign to most ems agencies other than they know it involves nuclear radiation but apart from that if you ask them what their plans are for this type of incident they look at you with a blank face or the deer stuck in the headlights look.

I think we are in trouble if something big happens.

[Richard B the EMT]

FYI: FDNY and the FDNY EMS have a pager sized radiation detector that at least one crewperson is supposed to wear on any and all calls. But, supporting the observation of "only seeing the mushroom cloud", many of my people leave it on the vehicle visor, protecting the vehicle quite well, but not the people.

[CivilDefense2002]

medic2588: I apologize if you feel my questions are of a sensitive nature. It is not my intent to reveal any classified information, of course. However, I have yet to encounter much in the way of classified or sensitive material in the emergency preparedness or civil defense field. The standard operating procedures, forms, and other documents for the DOE's Federal Radiological Monitoring Assistance Center (FRMAC) - arguably one of the more sensitive RADEF institutions - are available online.

Richard B, the EMT: I noticed one thread on people carrying radiation pagers where the FDNY pagers came up. I'm wondering what kind of training came with the issuing of the instruments. A lot of agencies seem to buy new toys and never teach their guys how to use it. Many only know that it's "bad" if it alarms, but I haven't met anyone who can tell me what type of dose or dose rate they can remain in for lifesaving, etc.

A lot of guys will say they will never go near an incident scene for any reason, even lifesaving, due to perceived risks. On the other hand, you've got the case where a state police agency encountered a wrecked radiopharmaceutical van and decided to monkey around it until hazmat came.

If there is interest, I can provide some sources for some really good training materials - in my opinion. For example, FEMA came out a few months ago with a neat video aimed especially at EMS, discussing the principles of contamination control in the ambulance. For example, they suggest treating the pt. completely out of jump bags, as they can be thrown away if necessary, unlike rummaging through (and possibly contaminating) the compartments.

CivilDefense2002

[Medic2588]

Civil - no need to apologize. I know what you're getting at and don't think you have any alterior motives. But we don't anyone saying anything about preparedness here that could be used against them.

We have Rad pagers for the EMS Task Force. Some of the ambulances in the state also have the radiation detectors in the ambulances. The problem with these is that they get set off by patients who recently had radiation stress tests.

Ruff - quite the contrary. We are probably best prepared to respond to a radiation incident because of all the preparedness that went on during the Cold War. Responders being very very sick or very very dying is a misconception. You need Chernobyl type radiation levels to kill responders like that. That being said, there is still a problem with responder exposure. There really is no PPE to protect you from radiation, although SCBA will protect you from inhaling radioactive particles. The good news is, this is probably the easiest exposure level to measure, track, and predict medical effects. The detection equipment is extremely easy to use, with the right training and right practice - Which I think is what Civil is getting at.

Most places have created plans to respond to radiologicla incidents. Its up to everyone to make sure they are familiar with these plans. If you're reading this, encourage co-workers to review you plans and become more familiar with them. And if you find you don't have plans for it, feel free to PM me and I'll set you on the right path for planning.

Devin

[Richard B the EMT]

I don't remember who gave me my "training" for the radiation beepers, but it was something to the effect of, "If the thing starts beeping, take it off, place it down as a marker for hazmat to set up a 'zone' perimeter, and get the hell out, while calling it in on your radio."

Need I say that this was not in a classroom, but might have been told me by the guy I relieved on the ambulance?

[CivilDefense2002]

Medic2588: You are correct, the preparedness under the civil defense initiative during the Cold War would have ensured fairly decent preparedness for emergency responders in the event of a radiological incident of any kind. Most emergency personnel who worked in the 1970s seem to vaguely recall an 16-hour class where they played with yellow boxes.

Problem was, that in 1996 the "peace dividend" supposedly applied to the civilian world as well. FEMA cut funding to all civil defense programs, including RADEF. The vast majority of states ended their programs that year, and shipped their instruments to be sold at massive FEMA auctions. The remainder of states pretty much followed soon after. KS just ended theirs year before last. Besides MA, IA, FL, and OH, I know of no states which continued their programs, let alone expanded it like it needed to be. Granted, it was nowhere near where it needed to be, but it was a far better situation than there is today.

You are right. With a decent amount of training, some routine practice and occasional refresher classes, there is no reason any cop, fireman, or medic can't be fully ready for the threat of radiation emergencies. Equipment is a modest investment as compared to many other expenditures, and sometimes grants are available. With a little TLC and annual calibration, they'll work when you need 'em to. Trouble is that getting this very modest effort is like pulling teeth, often times...

Richard B, the EMT: That sounds all good and well in some type of vacuum where nothing else is going on. What if it alarms while you are walking up to an obvious severely injured pt at an MVA? What about approaching the thyroid cancer pt who just had radioiodine thyroid ablation? Do we run away and leave them to their deaths until the "mop and glow men" show up in a few hours?

What I want to know is how "the powers that be" who buy these things think that somehow they do anything more than cause more confusion and problems than they even begin to solve. Why haven't they trained you - in a real class - at what dose and dose rate you will have to worry about breaking intentionally deflated regulatory limits, worry about increased risk of cancer 30 years down the road, or worry about acute radiation injury that can kill your fast-replicating cells and cause anemia and leukopenia in the short term? What's safe to go through to save property? To save lives? To save a school bus full of tiny schoolchildren and nuns? 8)

Quick question, what brand and model "page" did they get you. Some "know-it-alls" have been trying to convince everybody out there that a $1600 pager-type device that reads only up to 3.8 mR/hr and has an esoteric 0-10 numerical display that relates to nothing is somehow one of the best choices. Supposedly they think it's better than the $400 Canberra UltraRadiac - which not only registers very low levels, but also up to 500 R/hr for serious emergency response in a radiological incident. Apparently the second or two more it takes for the UltraRadiac to alarm at the 2 mR/hr control line the regulatory pencil-pushers want as a turn-back is worth three times the cost and nowhere near the functionality...

Sigh...

On a related note, just like Medic2588 offered, feel free to pm me and I'll see what I can do to help in regards to RADEF preparedness. My specialty is instrumentation really, outside of that I can only point you in the right direction to someone who can.

Not to pimp my own state too much, but we've got an innovative program here whereby we have a custom made circuit board and other components to completely rebuild the old 1962 vintage CD V-700 low-range instruments into an instrument rivaling - or better than - any other low-range "Geiger counter" type instrument you can buy today. There is a little assembly required, but just about any monkey with a soldering gun, drill press, and spray paint can do it - myself included. Best part is total cost ends up to be half-price of buying new "new" stuff.

CivilDefense2002

[Medic2588]

Civil,

Not sure the exact brand we have since its not in my possession in the office at the moment, but I don't believe it cost more than $250 a pager. And these were recommended by the Nuclear Medicine/Safety people at one of our cancer treatment centers so I'm pretty confident they'll pick up radiation.

Devin