epid_651_final draft for class

7/31/2019 Epid_651_Final Draft for Class

1/36

Radiological Spill of Cobalt-60 in

Washtenaw County

Zishaan Farooqui, Laura Hartman,

Kristen Light, Erin Sehnert, MichaelWu


2/36

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


3/36

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.


4/36

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.


5/36

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.


6/36


7/36

Identification of the Hazard

Who will identify the radiologic hazard?

What parameters regarding the hazard are

important to know?


8/36

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


9/36

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.


10/36

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.


11/36

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?


12/36

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.


13/36

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?


14/36

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


15/36

Key Personnel

Public Health Director and Health Officer -

Richard Fleece

Public Health Preparedness Coordinator

Cindra James

Nurses

Physicians

Public Health Officials


16/36

Role of Public Health

What is the role of the

Washtenaw CountyHealth Department in

this response?


17/36

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


18/36

Communications


19/36

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?


20/36

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.


21/36

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?


22/36

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?


23/36

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.


24/36

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.


25/36

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


26/36

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?


27/36

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


28/36

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


29/36

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


30/36

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.


31/36

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?


32/36

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


33/36

Long-term Surveillance

Assess symptoms

Document physical exam

vascular insufficiency

signs of cancer

Repeat cobalt testing

Determine need for radiologic studies


34/36

Do you have any remaining thoughts or

questions about the scenario?


35/36

Tabletop Exercise Evaluation

Please use the recorders notes to evaluate

the exercise.

Discuss possible implications for emergency

preparedness within Washtenaw County

Health Department.


36/36

Thank you!

epid_651_final draft for class

Documents