epid_651_final draft for class
TRANSCRIPT
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Radiological Spill of Cobalt-60 in
Washtenaw County
Zishaan Farooqui, Laura Hartman,
Kristen Light, Erin Sehnert, MichaelWu
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Tabletop Exercise Instructions
Designate a recorder to take notes
Discuss your role in the response relative to
your actual position at the health department
Work together to discuss actions necessary to
resolve the situation
Evaluate the exercise using the recordersnotes
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February 05
It is a sunny day with 10 mph winds blowingNorthwest, temperature of 23 degrees F.
The roads are icy.
At 8:50 am, a truck carrying medical waste fromthe Radiology Department at University of
Michigan Hospitals in Ann Arbor is traveling
eastbound towards Ypsilanti on WashtenawAvenue.
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At 9:05 am, a 9-1-1 call is received reportingan accident involving the truck at theintersection of US-23 and Washtenaw.
The truck crashed into the overpass columnand tipped over.
The truck has a sign indicating radioactive
material. The driver appears to be injured.
No other cars are involved.
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Devices, possibly containing the radioactivematerial, have fallen out of the truck.
A policeman arrives at the scene and calls the fire
department, HAZMAT, and EMS. HAZMAT later identifies the material as Cobalt-
60.
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Identification of the Hazard
Who will identify the radiologic hazard?
What parameters regarding the hazard are
important to know?
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Cobalt-60
A synthetic radioactive isotope of cobalt with ahalf-life of 5.27 years.
Co-60 is a hard, gray-blue metal that resembles
iron or nickel Its used for sterilization of medical equipment,
radiation source for medical radiotherapy, foodirradiation and blood irradiation
Commercially found as Co-60 rods with doublemetal shielding or found in medical devices usedfor sterilization
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Radiological Contamination
Radioactive contamination occurs whenradioactive material is deposited on or in anobject or a person.
Radioactive materials released into theenvironment can cause air, water, food,surfaces, soil, plants, buildings, people, oranimals to become contaminated.
A contaminated person has radioactive materialson or inside the body.
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Radiation Exposure
Relatively smaller doses result in gastrointestinal effects such
as nausea and vomiting and symptoms related to falling
blood counts such as infection and bleeding.
Stored in blood, liver, kidneys, bones
Excreted in urine
Children are more sensitive to radiation than adults
Decrease, Distance, Shield
People in the immediate surrounding area should take
personal protective measures.
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General Discussion Questions
Who is in charge of the response?
What actions should be taken next?
Who should be notified?
Should the two major roads be blocked off and shouldthe shopping areas near the area be evacuated? If so,how will people be notified? What otherconsiderations should be made?
What steps should be taken to re-open the roads andshops?
What is the role of the County Health Department?
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The driver has suffered traumatic injuries and
is rushed to the hospital to be stabilized.
The tipped over truck is still partially blocking
Washtenaw avenue. No action has been
taken regarding radioactive material as of yet.
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Chain of Command during a Disaster
Who is in charge? Who are key personnel?
How is your chain of command established?
What is your individual role?
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Establishment of Incident Command
Will help determine who is in charge of the publichealth response
Can be used for EMS as well as for County PublicHealth Dept
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Key Personnel
Public Health Director and Health Officer -
Richard Fleece
Public Health Preparedness Coordinator
Cindra James
Nurses
Physicians
Public Health Officials
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Role of Public Health
What is the role of the
Washtenaw CountyHealth Department in
this response?
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The Role of Washtenaw County Health
Department
Public Health will be contacted after initial cleanup
Will require nurses/epidemiologists for short
term assessment as well as long term
Will require environmental health assessment for
exposure and risk
Will need to interact with stakeholders (local and
state government, media, university, etc) to relayinformation to the public regarding safety
precautions
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Communications
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Pre-disaster Coordination
Who do you have connections with?
Who can you count on to pool resources that
may be especially depleted during a disaster?
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Back to the Scenario
ICS is in place.
As public health professionals, we turn our
attention to radiologic concerns of those
involved in the accident and response and
concerns of the public.
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Concerns about Close Contact
The driver and the first responders were in
close proximity to the Cobalt-60 but did not
touch it. What precautions should they take?
HAZMAT will provide initial clean-up and
appropriate disposal of the devices. What
precautions should they take?
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The 9-1-1 caller was an EMU student walking
towards the nearby bookstore. While he was
waiting for the police, he moved some deviceshoping to find out what the truck was
carrying.
How do you decontaminate him?
What are short and long term concerns after
contact with radioactive material?
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Decontamination
Skin or wound contamination is almost never immediately life threateningto the patient or to medical personnel. Therefore, treating conventionaltrauma injuries is the first priority. Decontaminate the patient only aftermedical stabilization. Ideally, Emergency Medical Services personnel willdecontaminate patients at the scene of an incident prior to transport.
Removal of outer clothing and shoes can reduce contamination by as
much as 90%. Assess for radiological contamination by slowly passing a radiation
detector over the entire body, insuring that the same distance ismaintained in subsequent surveys.
Cover open wounds prior to decontamination of surrounding skin.
Remove contaminated clothing and place it in marked plastic bags, movingit to a secure location within a contaminated area.
Wash bare skin and hair thoroughly, and if practical, secure andappropriately dispose of the effluent.
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Recommended Cleaning Solutions
For skin and wound decontamination, use a cleaningsolution.
Soap and water or normal saline
Povidone iodine and water
Hexachlorophene 3% detergent cleanser and water
To decontaminate hair, use any commercial shampoowithout conditioner.
Conditioners bind material to hair protein, makingcontamination removal more difficult.
Consider clipping hair to remove contaminants.
Avoid removing eyebrows since they may not grow back.
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Medical Concerns after Contact
Short term local skin injury
hematopoietic syndrome = bone marrow depression withinfection and hemorrhage in several weeks
gastrointestinal syndrome = nausea, vomiting, diarrhea,recurrence in 1 week
acute radiation syndrome = nausea, vomiting, seizures,hypotension
possible death
Long term cancer
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Public Relations
What information would you include in a
public relations message to inform the general
population?
Who are the people that we are trying to
inform?
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Public Relations
HOW TO COMMUNICATE EFFECTIVELY IN A CRISIS
Crisis communications efforts will be more successful if
you anticipate:
what may happen what questions may be asked
who should address various questions
how to get messages out to the media and the public
effectively
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Public Relations cont.
Communicate with liaisons from theseinstitutions:
University of Michigan
Eastern Michigan University St Joseph Hospital
University of Michigan Hospital System
General public
Radio and TV stationsOther forms of information:
texts/voice messages
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Remember to:
Consider the needs of special populations.
Be sure to have plans in place to communicate
with special populations such as:
Schools Non-English speaking groups
Home-bound and disabled individuals
Homeless people
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Example of General PSA
This is a spill of hazardous material that is radioactive.
Local response teams are trained to respond to a variety ofhazardous materials including radioactive materials.
Emergency responders are on scene and following well-establishedprocedures to protect the public.
The extent of the problem is limited to the immediate area of theaccident.
The radioactive material has been contained.
Responders will make recommendations for protective actions ifthey are needed.
We are working to detour traffic around the accident.
We continue to monitor the situation and will provide updates.
We expect cleanup to proceed rapidly.
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The accident was cleared, and all immediateconcerns have resolved.
Local physicians, businesses, schools, and thegeneral public have been notified.
NowWhat public health surveillance activities needto occur as a result of this accident?
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Initial Surveillance
Onset of specific symptoms
Time of arrival at scene
Duration of exposure at scene
Distance from the source
Use of PPE (respirators, clothing, gloves)
Urine test for cobalt versus whole-bodycounting with portable device
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Long-term Surveillance
Assess symptoms
Document physical exam
vascular insufficiency
signs of cancer
Repeat cobalt testing
Determine need for radiologic studies
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Do you have any remaining thoughts or
questions about the scenario?
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Tabletop Exercise Evaluation
Please use the recorders notes to evaluate
the exercise.
Discuss possible implications for emergency
preparedness within Washtenaw County
Health Department.
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Thank you!