Local Hospital's Action Guide

Actions (as appropriate and practical):

• Operate under the Incident Commander and follow personnel protection guidelines
• Brief health care staff that the risk from a contaminated person is negligible if they follow personnel protection guidelines
• Have law enforcement provide a cordoned area around the hospital(s) to redirect self-presenters (worried-well) to the secondary location for monitoring/reassurance established by the resource coordinator
• For a security event, coordinate with the Law Enforcement/Security Team and FEMT to:
  • provide protection/security for the hospital
  • preserve evidence
• Make arrangements to screen arrivals for dangerous sources (ambient dose rate >100 µSv/h at 1m) and isolate such sources if found
• Prepare an ambulance reception area and treatment area for receiving casualties:
  • Designate an ambulance reception area and treatment area. Set up an area large enough to handle the anticipated number of victims. Clear the area of visitors and patients. Re-route the traffic of other patients as appropriate, e.g. direct other medical emergencies to another hospital entrance. Make a path from the ambulance entrance to the hospital entrance using rolls of plastic, wrapping or butcher paper about 1m wide. Cover the floor. Tape the covering securely to the floor. Remove or cover equipment that will not be needed. Rope off and mark the route to prevent unauthorized entry
  • Restrict access to the controlled treatment area
  • Prepare several large plastic-lined waste containers; plastic bags of varying sizes and labels for personal effects; warning labels and signs
  • Prepare the decontamination room of the treatment area if one has been previously designated. Otherwise, designate a decontamination room near the entrance. Establish a control line at the entrance to the decontamination room. Use wide strip tape to clearly mark the floor at the entrance to the room to differentiate the controlled (contaminated) from the non-controlled (uncontaminated) side. Check and prepare survey meters for use (if available)
  • Prepare enough instruments and supplies (e.g. outer gloves, dressings) to change when they become contaminated

• Prepare the medical staff. Use universal precautions. Use two sets of gloves (outer gloves should be easily removable and replaced between patients)
• Meet the victims at the established location. Request that ambulance personnel stay in their vehicle until surveyed and released by first responder monitor/radiological assessor. Survey of the ambulance may be delayed if a large number of victims must be transported.

• Assess and treat injuries (assume the patient to be contaminated):
  • Perform medical stabilization first; if necessary for life saving, bypass the decontamination room. Remove the patient's clothing and wrap the patient in a sheet to limit contamination of the treatment area
  • Conduct a radiological survey (by the first responder monitor/radiological assessor — if he/she is available and if actions do not interfere with medical actions or adversely influence the patient's medical status)
  • Perform physical examinations and blood tests (complete blood count with differential) promptly

• If the patient could not be checked by the first responder monitor/radiological assessor (if not available or because assessment may worsen the patient's health condition) patient(s) should shower and change into a hospital gown or other suitable clothing (if these actions will not adversely affect patient's medical status)

• If patient is contaminated, proceed with full decontamination:
  • Remove clothing and place in a labelled plastic bag
  • Perform a radiological survey (by first responder monitor/radiological assessor)
  • Decontaminate the skin with soap using warm water. Do not scrub too vigorously. Handle any unknown metal objects with a hemostat or forceps
  • Save samples and label them (smears of contamination, nasal smear, extracted tooth, hair and nails, purged bone pieces, etc.)
  • If a wound is contaminated, survey, rinse, debride only for surgical reasons
  • If contamination persists, consider covering area or consider that contamination may be internal
  • Perform a final radiological survey (by the first responder monitor/radiological assessor)
• Transfer the uncontaminated patient to the clean area. Use clean gloves to move the patient to a clean stretcher and exit the contaminated area
• Control the spread of contamination:
  • Survey staff for possible contamination; remove contaminated clothing and shower before exiting contaminated area. Survey medical equipment for contamination before removing it from the contaminated area
• Direct media inquires to the PIO
• After discharging the patient and at the end of the emergency phase clean up the area following the procedures established by the radiological assessor to control doses. Do not return the area to normal until approved by the radiological assessor
• Segregate presumptive or confirmed radiological waste for retrospective analysis if considered necessary and in consultation with a member of the FEMT
• Assess needs and request additional resources if needed. Request a consultation from national experts or inform the national EOC on the need for international assistance (if necessary)