Community reception center exercise tests Florida's radiological screening and decontamination process

In Brief

In the summer of 2011, the Florida Department of Health held a community reception center exercise to test its capacity to respond to a radiological emergency. Years of training responders, purchasing specialized equipment, and developing partnerships led to a successful exercise of such skills as screening and dosimetry, decontamination, and medical triage.

Background

State and local health departments across the country have been planning to address radiological threats, whether accidental (eg, incidents at nearby nuclear power plants) or man made (eg, radiological dispersal devices or "dirty bombs"). Following a radiological incident, public health agencies will monitor the affected population for contamination in community reception centers (CRCs). While falling under the purview of public health or emergency management agencies, radiological preparedness is an interdisciplinary endeavor, requiring expertise from industry and the physical/environmental sciences.

Specific issues
  • Need for a multi-agency preparedness and response effort. A response to a radiological emergency requires staff, communications efforts, and technical expertise from different agencies and specialties (eg, public health, environmental health, emergency management, nuclear specialists, and medical physicists).
  • Insufficient training for responders. A 2006 radiological response exercise in a Florida county revealed that responders had little knowledge about surveying victims for contamination, using probes, triaging, and decontaminating injured victims, and establishing threshold levels and dosimetry for responders and victims. Additionally, responders did not have access to the proper equipment to thoroughly screen potentially contaminated victims.
  • Inadequate understanding of radiological implications in the healthcare system. The 2006 exercise illustrated that many injured victims did not receive proper treatment. Responders failed to consider internal contamination, failed to triage victims for medical care, and forced severely injured victims to wait for decontamination before transporting them to hospitals.
The practice

The Florida Department of Health (FDOH), along with other federal, state, and county agencies, held a CRC exercise to evaluate its ability to screen for contamination following a radiological disaster.

In summer 2011, FDOH created a complex CRC at Orlando's Cypress Creek High School to test several advances it had made in planning to help exposed or contaminated people during a radiological emergency. Considerations integrated into the exercise included:

  • Site selection. Because FDOH needed to test its ability to decontaminate people, a site that could be divided into contaminated areas and clean zones where people were not at risk of re-contamination was essential. Other important factors were the presence of multiple showers and appropriate space to decontaminate families and people with disabilities.
  • Personnel. Responders and volunteers from a variety of disciplines participated in the exercise. The group was comprised of FDOH epidemiological and environmental strike teams; CDC staff; and a Medical Reserve Corps comprised of health physicists, staff from industrial and research facilities, power plant staff, and NASA personnel, many of whom had extensive experience with radiological screening equipment.
  • Equipment purchase and use. In order to assure that people were screened and decontaminated with the most accurate technology available, FDOH purchased hundreds of probes (for externally scanning skin and clothes to measure the presence of radioactive particulates), walk-through portals, and dosimeters to measure the radiation dose at all locations within the CRC. Responders were trained in the careful operation of these instruments.

The scenario forming the exercise's premise was possible water contamination with cesium-137 (an isotope that emits gamma and beta radiation) during a political conference. More than 300 people would require screening and potential decontamination.

To provide the most comprehensive drill possible, planners divided the high school auditorium into seven stations:

  1. Initial sorting and screening. Staff triaged people immediately as they arrived, determining whether victims needed emergency medical care, had received a potentially large dose of radiation due to extensive radiological contamination, or required an escort or services for special needs.
  2. First aid. Clinical staff assessed injured people before they received any decontamination procedures. The first aid station was situated near an exit to ensure that ambulances could easily access anyone who required emergency transport, and ambulance staff were informed about the possible need for personal protective equipment (PPE) to minimize risk of contamination when handling the patient.
  3. Contamination screening. Staff used walk-through portals and handheld probes to screen people for contamination, ensuring that people who had already been decontaminated and needed to be re-screened were able to use an express lane.
  4. Washing. Staff and volunteers simulated a wash area which ensured that contaminated individuals knew how to use the showers, that families were kept together, and that hair conditioner was not distributed (conditioner binds radioactive material to the hair).
  5. Registration. Planners added fields for CRC data to the agency's existing Web-based surveillance system. Volunteers collected epidemiological information from victims, including contact information, demographics, proximity to the radiological event, length of exposure, any medical care received, and contamination screening results. Using a modified online system allowed staff to enter victim data in the CRC and provided an exportable line list that could be available within 30 minutes.
  6. Radiation dose assessment. Health physicists screened victims for potential internal contamination (probable if people had been decontaminated multiple times and still had positive results on external screening) and considered their exposure and need for bioassay (urinalysis). If victims were found to need bioassay, staff outlined their potential need for treatment and prioritized them for follow-up.
  7. Discharge. As people left the CRC, they were provided information on radiation exposure and any follow-up treatment. Staff also offered behavioral health counseling at this station.
What made this practice possible?
  • Diverse agency participation. Numerous federal, state, and local agencies partnered to develop and staff the CRC, including CDC, FDOH, FDOH Radiation Control, FDOH epidemiological and environmental strike teams, the Florida Medical Reserve Corps, Florida State Medical Response Team - Region 5, Florida Regional Domestic Security Task Force Region 5 Incident Management Team, Orange County Health Services, Orange County Department of the Medical Director, SciMetrika LLC, and East Central Florida Regional Planning Council.
  • Prioritization of radiological readiness. FDOH had spent years identifying gaps in its radiological preparedness capabilities, seeking out specialized funding, buying screening equipment, and training staff.
  • Extensive training. FDOH trained responders using the CDC Web-based tool "The Virtual Community Reception Center," which allows trainees to experience an animated CRC and an interactive patient flow diagram. Staff also received training in radiological incident response, instrumentation and dosimetry, and radiation emergency medicine. In addition, the FDOH epidemiological strike team received training on specimen packaging/shipping and data entry into an online outbreak system.
  • Investment in specialized equipment. FDOH used a Department of Homeland Security grant to purchase radiological screening equipment, including 200 friskers, 200 high-range instruments, 22 scintillation-based mobile portals, 200 electronic dosimeters, and 40 digital survey meters with pancake and NaI (sodium iodide) probes.
  • Supply caches. FDOH used supplies from various departmental response caches, including office supplies and radios from the Cities Readiness Initiative cache; first aid materials, cots, and wheelchairs from the Special Needs Shelter cache; and Wi-Fi satellites and radios from the Emergency Operations Center cache.
Results
  • Use of skills learned during the CRC training and drill. Shortly after the CRC drill was held, FDOH needed to actually screen for internal contamination of strontium-82 and strontium-85 from people receiving cardiac Positron Emission Tomography (PET) scans. FDOH radiation control staff and epidemiological strike team members screened 124 potentially exposed people using many of the same processes they had practiced during the exercise.
  • Lessons learned. Planners indicated that escorts and behavioral health staff positioned throughout the CRC were helpful for maintaining proper flow, especially when addressing the needs of small children or distraught people. They noted that consultations with the state radiation control authority provided guidance on adapting the CRC structure and process for people with disabilities.

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