Basic Radiation Training

BASIC RADIATION TRAINING Hospital Medical Personnel Alabama Department of Public Health • Office of Radiation Control • 334.290.6244 • alabamapublichealth.gov/radiation 2021

Kevin Hicks, Director Emergency Planning & Environmental Monitoring [email protected]

Michael Hallman, Radiation Physicist Senior [email protected]

Tanner Jackson, Radiation Physicist [email protected] Basic Radiation Training Hospital Medical Personnel (HMP)

Alabama Department of Public Health Office of Radiation Control PHYSICAL: ADPH Training Center & Administrative Complex 208 Legends Court, Prattville, AL 36066 MAILING: P. O. Box 303017, Montgomery, AL 36130-3017 T: 334.290.6244 F: 334.285.9342 www.alabamapublichealth.gov/radiation Kevin Hicks, Director Emergency Planning & Environmental Monitoring Branch [email protected] Michael Hallman, Radiation Physicist, Senior [email protected] Tanner Jackson, Radiation Physicist [email protected] 24-hour ADPH ORC Duty Officer 334.324.0076

1 Table of Contents • QR Codes/URLs for Videos 5 • Alabama’s Nuclear Power Plants 6 • Alabama Radiological Emergency Response Plan 7 • Emergency Classifications Levels 8 • Radiation 9 • Roentgen Equivalent Man (REM) 10 • Average Annual Radiation Exposure 11 • Radioactive Material in Alabama 12 • Two Types of Radiation 13 • Ionizing Radiation: Alpha, Beta, and Gamma 14 • ALARA 15 • Controlling Exposure 16 • Protection from Radiation – Time 17 • Protection from Radiation – Distance 18 • Protection from Radiation – Shielding 19 • Exposure, Contamination & Decontamination 20 • Radiation Pathways 21 • Avoid Radioactive Contamination 22 • Contaminated Injured 23 • Radiation and Our Five Senses 24 • KI (Potassium Iodide) 25 • Pocket Dosimeters 26 • Radiation Exposure 27 • Thermoluminescent Dosimeter 28 • Placement of TLD & Pocket Dosimeter 29 • Total Effective Dose Equivalent (TEDE) 30 • Radiation Dosage Limits for EWs and PEMs 31

The Federal Emergency Management Agency (FEMA), an agency of the Department of Homeland Security (DHS), is required to interview a certain number of emergency workers, personnel and equipment monitors to ensure that they are aware of their radiation dose limits, equipment, and the basics of radiation. The training manual has the following features: •Table of contents for looking up the answers for exercises, evaluations, real-time emergency situations •Forms located in the back of the book that can be used for reception centers, personal radiation exposure records, equipment setup, etc. •Maps for the two nuclear power plants’ 10-mile Emergency Planning Zones (EPZ) and the 50-mile Ingestion Pathway Zones (IPZ). •Glossary in the back of the book with radiation terms not routinely used.

Formatting for this guide is as follows: 1. Information on the PowerPoint slide 2. Information below the PowerPoint slide in the Notes section 3. Information discussed in the Basic Radiation Training course by the instructor

Everything you need to know about protecting yourself from radiation can be found in this manual. Therefore, please place this manual in a readily accessible location.

2 Table of Contents

• Reminders for EWs and PEMs 32 • Emergency Worker Equipment 33 • CDV-750 Dosimeter Charger 34-35 • EW Assessment 36 • Radiological Guidance for Hospital Personnel 37 • Notification and Communication 38 • Emergency Contact Information 39 • Hospital Supply Requirements 40 • Preparation of Radiation Emergency Area (REA) 41 • Hospital Ventilation 42 • Response Team Preparation 43 • Radiation Patient Treatment Algorithm 44 • Patient Transfer 45 • Patient Assessment and Triage 46 • Removing Contaminated Clothing 47 • Sample Collection 48 • Types of Radiation Injuries 48 • Types of Radiation Injuries: Irradiation, Contamination, and 49-50 Incorporation • Wound Care for External Contamination 51 • Wound Injury 52 • Decontamination for Intact Skin 53 • Detecting Internal Contamination 53 • Treatment for Internal Contamination 54-55 • Discharging the Patient 56 • Patient Movement Out of the REA 57 • Exit of Hospital Personnel 58

Table of Contents

• Final Close Out of Radiation Emergency Area (REA) 59 • Radiation Emergency Assistance Center/Training Site 60 • HMP Feedback 60 • Radiological Survey Meters 61 • Ludlum 14C Features 62 • Radiation Contamination 63 • Radiological Survey Meters 64 • Ludlum 14C Scales 65 • Radiation Detection Equipment 66 • Ludlum 14C – What is the Meter Reading? 67-71 • Techniques for Monitoring for Contamination 72 • Survey Meters – Monitoring for Contamination 73 • Ludlum 14C – Surveying the Thyroid Gland DISCONTINUED 74 • Radiation Dosage Limits for Personnel/Equipment 74 Monitors CONSOLIDATED WITH EMERGENCY WORKERS • Thyroid Uptake Limits DISCONTINUED 75 • Reminders for PEMs 76 • Safety Briefing 77 • Ludlum 14C – Set up & Operation 78 • Ludlum 14C Just In Time Website (ADPH version) 79 • PEM Feedback 79 • Glossary 80-81 • Just in Time Videos 82 • Radiation Exposure Record 83 • Radiation Equipment Distribution Log 84 • Donning & Doffing Procedures 85-86 • REAC/TS Donning/Doffing Guides 87-88

3 Table of Contents

• Just-In-Time Training: Direct Read Dosimeter 89-90 • Just-In-Time Training: Ludlum 14C Survey Meter 91-92 • REAC/TS Monitoring a Patient Guidelines 93 • REAC/TS Patient Radiological Survey Sheet 94 • REAC/TS Area Radiological Survey Sheet for Decon of Room 95 • Browns Ferry Nuclear Plant 10-mile EPZ Map 96 • Browns Ferry Nuclear Plant 50-mile IPZ Map 97 • Farley Nuclear Plant 10-mile EPZ Map 98 • Farley Nuclear Plant 50-mile IPZ Map 99 • Example HMP Safety Briefing 100

4 QR codes/URLs for Videos

Video: 4 types of ionizing radiation: Alpha, Beta, Gamma, & Neutron https://youtu.be/2fIylibGJYM

Video: Time, Distance and Shielding https://youtu.be/2AcqRD5TTpc

Video: Radiological Basics https://youtu.be/QiwFg60V5DE

Video: Biological Effects of Radiation https://youtu.be/wMySBZ4GwCw

Video: Radiological Dosimetry https://youtu.be/qKtKaLkW5fk

QR codes/URLs for Videos

Video: Hospital response to radiation emergencies https://youtu.be/hidRHAj0fQ8

Video: CDC’s Radiological Terrorism: Just in Time Training for Hospital Clinicians” https://youtu.be/e1LJWWe4StQ

5 Nuclear Power Plants • Alabama: Two active nuclear power plants – Browns Ferry – Joseph M. Farley

• BFNP 10-mile EPZ – 4 risk counties – 1 host county • FNP 10-mile EPZ – 2 risk counties

• 50-mile IPZ

• Universal Training and Equipment

In Alabama, there are two nuclear power plants: Farley Nuclear Plant in Houston County near Dothan, Alabama, and Browns Ferry Nuclear Plant in Limestone County near Athens, Alabama.

Browns Ferry has four risk counties (counties within the 10-mile EPZ) and one host county for the overflow of the evacuees. The risk counties are Limestone, Morgan, Lawrence, and Lauderdale. The host county is Madison.

Farley has only two risk counties (Houston & Henry). Because of geographic ownership of the Chattahoochee River, we share responsibility with Georgia (via Early County).

We train all emergency workers and personnel & equipment monitors in the 10-mile EPZ. We also have a different training program for the ingestion pathway counties (50-mile IPZ).

Training, equipment, and documentation are all standardized across the entire state of Alabama. Therefore, trained personnel can easily assist with a radiological event at either nuclear power plant, if requested.

6 Radiological Emergency Preparedness (REP) Plan • Plan for OFF-SITE emergency response & recovery. • Utility is responsible for ON- SITE emergency response & recovery. • County plan is specific and identifies responsible organizations. • Hospital plan for radiological events or incidents • State plan for radiological events or incidents with specific ADPH ORC Incident NEW! Annex

The Radiological Emergency Preparedness (REP) Incident Annex E of the State of Alabama Emergency Operations Plan (EOP) is the plan for dealing with radiological emergency response. The plan details the concept of radiological emergency planning and operation for off-site emergency response and recovery in the event of a radiological accident at a nuclear power plant. The plan is reviewed and updated annually. During an evaluated exercise, FEMA/DHS evaluates us according to our plan. As long as we follow our plan and procedures, we can’t go wrong! The county EMAs take what is needed from the state plan and put it in their county plan. The county plan is tailored to a county’s needs. If you are a county emergency responder, then follow your county plan. No one agency can handle a radiological emergency alone. We must build and rely on partnerships from the States, Counties, Utilities and Federal agencies. Contract hospitals for Browns Ferry Off-Site Organization (ORO) Response: Decatur Morgan Hospital – Main Campus Decatur Morgan Hospital – Parkway Campus Huntsville Hospital Contract EMS Services for Browns Ferry ORO Response: Greg’s Ambulance Service (Lawrence County EMS) Lifeguard Ambulance Service First Response Ambulance Service Contract Hospitals for Farley ORO Response: Southeast Health Medical Center Flowers Hospital Contact EMS for Farley ORO Response: Pilcher’s Ambulance (Dothan Ambulance Service)

7 Emergency Classification Levels • General

Emergency (GE) BWR: Boiling Water Reactor • Site Area (Browns Ferry Nuclear Plant) Emergency (SAE) • Alert • Notification of Unusual Event (NOUE) PWR: Pressurized Water Reactor (Joseph M. Farley Nuclear Plant)

There are four Emergency Classification Levels (ECL) at all U.S. nuclear power plants. Nuclear power facilities use the ECLs as the method of communicating different types of incidents. Each ECL describes the specific actions that must be completed by both the licensee and the offsite emergency responders. Emergency classifications are declared for events that are occurring or have occurred affecting plant radiation safety or plant security. Each time an ECL is declared or changed, the State Emergency Operations Center (EOC) and/or the Utility (owner of plant) is required to make notifications to the responsible state agency: the Office of Radiation Control (ORC). Notification of an Unusual Event – The least serious of the four classifications. Events in this class indicate: •Potential degradation of plant safety •Security threat to facility protection is initiated •No release of radioactive material unless plant conditions degrade Alert – Events in this class indicate: •Potential or actual degradation in plant safety •Lives of onsite personnel may be threatened or site equipment may be damaged due to a hostile action *Prattville’s State Radiological Monitoring & Assessment Center (SRMAC) will stand up and monitor the situation closely. This includes watching radiation levels for the pressurized ionization chambers (PICs) installed around both nuclear plants. Site Area Emergency – Events in this class indicate: •Actual or likely plant functions failure. Plant functions would be needed to protect the public’s health and safety •Hostile actions that result in an intentional damage to plant personnel or equipment used to protect the public •Malicious acts that could lead to failure of equipment used to protect the public or could prevent effective access to said equipment used to protect the public *If not already accomplished, Radiation Control will issue two health orders: Public Warning and Restricted Access (of the 2- mile radius of the plant) and will send out radiological field monitoring teams to survey the area. We have state-trained and county-trained radiological field monitoring teams. *If not already accomplished, Radiation Control will move forward to the Decatur SRMAC (beside Morgan County EMA) or the Dothan SRMAC (beside Dothan/Houston County EMA). General Emergency – Events in this class indicate: • Actual or imminent significant core degradation or melting. •There is a potential for loss of containment integrity which may result in radioactive material to the atmosphere. • Hostile action that results in an actual loss of physical control of the facility *Based on the field measurements, wind speed, wind direction, and status of the plant, Radiation Control could issue evacuation health orders or other health orders that are applicable.

8 Radiation

Radiation is energy that gamma rays travels in the form of waves or high-speed particles. It occurs naturally in sunlight and sound waves. Man- made radiation is used in X-rays, nuclear weapons, nuclear power plants, and cancer treatment. gamma rays

Radiation is a process where energy travels from one point to another by waves or particles, like the waves on the surface of the ocean. Radiation comes in various forms. A good example is the sun. Radiation is used everyday to improve our quality of life, from medical treatments to warming leftovers.

Atoms are the basis for all matter, consisting of a nucleus made up of neutrons, protons, and electrons. Naturally, only certain combinations of protons and neutrons occur. Some are stable and some unstable. Stable nuclei have no excess energy, but unstable nuclei become stable by releasing energy. This releasing energy is commonly called radioactivity. Radiation takes the form of either non-ionizing radiation or ionizing radiation.

9 REM (Roentgen Equivalent in Man)

• A unit of radiation dose equivalent used to measure the amount of damage to human tissue caused by all types of ionizing radiation

The REM is the unit of dose equivalence and is the measure which accounts for the varying effects of different types of radiation on the human body. Two other units that are important in the scientific study of radiation are the ROENTGEN and RAD (radiation absorbed dose). But for our purposes, one roentgen equals one rad equals one rem.

Roentgen (R) is a unit of measurement for radiation exposure in air from x-rays or gamma rays.

RAD is an acronym for Radiation Absorbed Dose. It is a dose unit which is used to describe the amount of radiation absorbed by an object or person.

REM is an acronym for Roentgen Equivalent in Man. It is measurement of the effect of all types of radiation on the human body.

10 Average Annual Radiation Exposure

• ~620 mR/yr – ~310 mR from natural radiation – ~310 mR from man-made radiation – <1 mR from nuclear power generation

Virtually everything emits radiation. Radiation is a natural part of our environment. Radiation is in the air we breathe, the food we eat, the soil, our homes, sunshine, and even our bodies. Radiation is also present in consumer products such as tobacco products, smoke detectors, lantern mantels, and building supplies. The radiation naturally occurring or existing in our environment is called background radiation. The amount of background radiation varies from one location to another. People may also be exposed to radiation through medical procedures (diagnostic & therapy) and dental x-rays.

The health effects of radiation exposure to people are measured in units called millirem. A millirem is 1/1000th of a rem. On average, Americans receive a radiation dose of about 620 millirem each year. Half of this dose comes form natural background radiation. Most of this background exposure comes from radon in the air, with smaller amounts from cosmic rays and the Earth itself. The other half (310 millirem) comes from man-made sources of radiation which includes medical, commercial and industrial sources. In general, a yearly dose of 620 millirem from all radiation sources has not been shown to cause humans any harm. Less than 1 millirem comes from nuclear power generation.

• Protective Action Guide for Nuclear = 1,000 millirem Power Plants Evacuations • Chest X-ray (posterior/anterior) = 10 millirem • Panoramix Dental X-ray = 1 millirem • Abdominal X-ray = 7 millirem • CT of Abdomen = 800 millirem • PET Scan for Cancer Staging = 1,410 millirem • Cardiac Stress Test with Thallium-201 = 4,070 millirem • PET CT = 4,500 millirem

11 Radioactive Material in Alabama

• Nuclear Power Plants

• Medical Uses

• Industrial Uses

• Research

• Naturally Occurring Radioactive Material (NORM)

• Waste Isolation Pilot Plant (WIPP)

In Alabama, we have two nuclear power plants and approximately 400 licensees that are authorized to use radioactive material. The types of licensed uses include medical, industrial and research. We also have naturally occurring radioactive material or (NORM) in the state. In addition, the Department of Energy (DOE) has shipments of low level waste as part of the Waste Isolation Pilot Plant (WIPP) that come down I-59 and I-20. Nuclear Power Plants: Browns Ferry and Joseph M. Farley Medical Uses: Medical uses include hospitals, cancer centers, cardiology clinics and nuclear pharmacies. Industrial Uses: Industrial radiography companies in Alabama use radioactive material to x-ray welds at temporary job sites including paper mills, chemical plants, shipyards, oil and gas pipelines, etc. Well logging companies use radioactive material to help study geological formations. Moisture density gauges are commonly used by highway construction crews at job sites to help determine moisture content and compaction of the soil. Research: Most of the universities in Alabama have radioactive material licenses for research purposes. NORM: Naturally Occurring Radioactive Material. In South Alabama around Citronelle or Gilbertown, you will find elevated levels of NORM due to the scale that has accumulated on the gas wells’ piping and in the tanks. If it is greater than 50 microR/hr at the surface, we require them to dispose of it through a radioactive waste broker. We have also seen piping from paper mills that had elevated radiation levels caused by kaolin clay used in the process. Kaolin is a white clay found primarily in Alabama and Georgia containing elevated levels of uranium and thorium decay series. In the paper process, it is used to produce high gloss for magazines and beer packaging. Up in Muscle Shoals, there is a giant slag pile with elevated radiation levels that exceed 100 microR/hr due to the byproducts created as part of the National Fertilizer Company in the 1970’s. This is under exclusive federal jurisdiction as part of TVA. WIPP: The WIPP program started in 1999 and its purpose is to secure national defense related transuranic waste below ground in the remote desert of New Mexico. Shipments come through Alabama from Oak Ridge National Lab and Savannah River National Lab. We are notified of these shipments and have computer access to track these shipments via GPS while they travel through Alabama. Transuranic waste is man-made isotopes that are heavier than uranium.

12 Two Types of Radiation

• NON-IONIZING: Radio and TV Waves, Infra-Red, Microwaves, UV-A & UV-B rays • IONIZING: Alpha & Beta Particles, Gamma Rays, X-rays, UV-C rays

There are two types of radiation: non-ionizing and ionizing.

Non-ionizing radiation has enough energy to cause electrons within atoms to move and vibrate but not enough to remove them from the atom itself. For example, microwave ovens use microwaves to force the electrons in food to move around, thus producing heat and heating the food. However, these electrons do not break away from the atoms of the food. We also come in contact with many types of non-ionizing radiation daily, such as the sun that delivers light and heat. Other examples of non-ionizing radiation include visible light and radar waves.

Ionizing radiation comes in two forms: particulate and waves/rays. Ionizing radiation is more energetic than non-ionizing radiation. Ionizing radiation has enough energy to remove electrons from atoms, thus forming ions. When ionizing radiation passes through material, it deposits enough energy to break molecular bonds and displace (or remove) electrons from atoms, thus creating ions. Ions are electrically charged particles which may cause changes in living cells of plants, animals, and people. These types of radiation are associated with nuclear power plant generation. In nuclear power generation, fission (splitting an atom’s nucleus) takes place which results in radiation being produced by splitting an atom’s nucleus and may be emitted in three forms: alpha particles, beta particles, and gamma rays.

13 Ionizing Radiation

Alpha particles

Beta particles

Alpha particle – A positively charged particle emitted from the nucleus of an atom. Alpha particles are charged particles, which are emitted from naturally occurring materials (such as uranium, thorium, and radium) and man-made elements (such as plutonium and americium). Alpha emitters are primarily used (in very small amounts) in items such as smoke detectors. In general, alpha particles have a very limited ability to penetrate other materials. In other words, these particles of ionizing radiation can be blocked by a sheet of paper, skin, or even a few inches of air. As a result, alpha particles do not usually make anything radioactive. Nonetheless, materials that emit alpha particles are potentially dangerous if they are inhaled or ingested, but external exposure generally does not pose a danger. Beta particle – A negatively charged particle emitted from the nucleus of an atom. In general, beta particles are lighter than alpha particles, and they generally have a greater ability to penetrate other materials. As a result, these particles can travel a few feet in the air, and can penetrate skin. Nonetheless, they can be stopped by several sheets of paper, a thick book, or even a sheet of aluminum or plastic. Beta particles are both an internal and external hazard which can damage the skin and cause second-degree burns and eye damage. Elements with beta emitters can be used for medical purposes, such as treating eye disease. Gamma ray – A photon originating from the nucleus of an atom. Gamma rays and x-rays consist of high-energy waves that can travel great distances at the speed of light and generally have a great ability to penetrate other materials. For that reason, gamma rays (such as cobalt-60) are often used in medical applications to treat cancer and sterilize medical instruments. Similarly, x-rays are typically used to provide static images of body parts (such as teeth and bones), and are also used in industry to find defects in welds. X-rays and gamma rays have great penetrating power and can easily pass through the human body. Thick, dense shielding, such as lead, is necessary to protect against gamma rays. The higher the energy of the gamma ray, the thicker the lead must be. X-rays pose a similar challenge, so x-ray technicians often give patients receiving medical or dental X-rays a lead apron to cover other parts of their body. Gamma rays are external and internal hazards. Gamma rays are an external and internal hazardous.

14 The ALARA philosophy is the foundation for all exposure (dose) limits. ALARA is based on the assumption that radiation exposure of any amount is a potential hazard. ALARA means making every reasonable effort to maintain exposures to ionizing radiation as far below the dose limits as practical, thus As Low As Reasonably Achievable.

Do not spend more time than necessary near a radiation source. Stay as far away from a radiation source as you can. Place material between you and the source of radiation.

Use a common sense approach when dealing with radiation!

15 Controlling Exposure

We cannot eliminate radiation from our environment. But we can, however, reduce our risk by controlling our exposure to it. Radiation is very easily detected. There are several simple, sensitive instruments capable of detecting minute amounts of radiation from natural and man-made sources. There are three ways in which people can protect themselves from ionizing radiation: 1.Time 2.Distance 3.Shielding

16 Protection from Radiation: Time

ShortenShorten time while being close to Less time with radioactive materials ionizing radiation = Less radiation exposure

For people who are exposed to radiation, in addition to natural background radiation through their work, the dose is reduced and the risk of illness essentially eliminated by limiting exposure time.

If you decrease the amount of time you spend near the source of radiation, you will decrease the amount of radiation exposure you receive. To imagine this, think of a trip to the beach as a comparison. For instance, if you spend a lot of time on the beach, you will be exposed to the sun, and, ultimately, get a sunburn. If you spend less time in the sun and more time in the shade, your sunburn will be much less severe. This is a comparison of how radiation exposure works.

The less time you spend in a radiation area, the less dose you will receive. Emergency workers will be assigned to work in a radiation area only for the amount of time required to accomplish their particular task.

For example, if you were working in an area where the exposure rate was 50mR/hr and you stayed there for one (1) hour, you would receive a dose of 50 millirem. But if you remained there for only a half an hour (30 minutes), you would receive half the dose or 25 millirem.

17 Protection from Radiation: Distance Keep away Greater the distance from ionizing radiation = Less radiation exposure

The farther away you are from a source of ionizing radiation, the less dose you will receive. In the same way that heat from a fire is less the farther away you are, the intensity of radiation decreases farther from its source.

Because of the inverse square law (1/d2), each time you double your distance from a point source of radiation, you will receive one-fourth (1/4) of the dose. If you triple the distance from a point source of radiation, you will only receive one-ninth (1/9) of the dose.

Example: If your exposure rate at a distance of one (1) foot from a point source of radiation is 100 mR/hr, then if the distance is doubled to two (2) feet away, then the exposure rate will now only be 25 mR/hr.

Example: The farther away you are from a radiation source, the less dose you will receive. Compare this to an outdoor concert. You can sit directly in front of a speaker, 50 yards from the stage, or on the grass in the park across the street. If you sit in front of the speaker, you will probably suffer some damage to your hearing. If you sit 50 yards from the stage, you will be exposed to an average amount of music. If you sit in the park across the street, the noise is even further reduced and you might not even hear the concert, or even know what song they are playing.

18 Protection from Radiation: Shielding

PlacePlace something heavy in between Thicker/Denser Material = Less radiation exposure

The use of shielding, such as lead, steel, concrete, or earth, between you and a source of radiation will also reduce your exposure. The amount of reduction depends on the type and thickness of the shielding material. Barriers of lead, concrete, or water give good protection from penetrating radiation such as gamma rays. Radioactive materials are therefore often stored or handled underwater, or by remote control in rooms constructed of thick concrete or lined with lead.

If you increase the shielding around a radiation source, it will decrease your exposure. For example, if you stand out in the rain without an umbrella, you will get wet. But, if you use an umbrella to shield you from the rain, you will remain dry and protected. This is similar to the idea of shielding in radiation protection.

So when possible, emergency workers in radiation areas should take advantage of shielding (standing behind buildings, cars, or some other means of shelter) to reduce their exposure. Keep something substantial between you and a point source of radiation. In the event of a radioactive plume, sheltering while the plume passes may be helpful.

19 Exposure, Contamination & Decontamination • Radiation is a type of energy

• Contamination is material

• Radioactive contamination emits radiation

• Exposure to radiation will not contaminate you

Radiation exposure is energy that passes through and may do damage but does not contaminate. So when a person is exposed to radiation it does not necessarily mean that the person is contaminated. In order to become contaminated, a person has to be physically in contact with the radioactive material. When radioactive material is where it is not wanted (e.g., on the ground, in water, or on you), we refer to it as “contamination”. Contamination is measured in counts per minute (cpm) and disintegrations per minute (dpm).

If someone is contaminated (externally), most of the material could be easily removed from the body by removing the clothing and washing with a mild soap and shampoo.

Example: We all go to the dentist and periodically receive an x-ray of our dental work. The energy of the x-ray travels through our tissue and teeth which develops the film to be read by the dentist. The x-ray passed through our teeth but did not physically touch our body in any way. Note: X-rays, CT scans, fluoroscopy, any machine producing radiation does not contaminate the patient.

If a radiological incident or accident occurs at a nuclear power plant in Alabama, the risk counties have procedures in place to open reception centers in order to monitor evacuees and emergency workers for radiation contamination and if needed, decontaminate. At reception centers, the evacuees and/or emergency workers can be decontaminated by gender, which typically takes place at school gymnasiums, recreation centers, or decontamination tents.

20 Radiation Pathways • Inhalation

• Ingestion

• Absorption

• Injection

External hazards of radiation dose are beta particles and gamma rays. Beta particles can cause burns to the skin. Gamma rays are very energetic and can penetrate through internal organs. Internal hazards of radiation dose are alpha particles, beta particles, gamma rays, and neutron particles. Once inside the body, they all become very harmful internal hazards. Radiological materials may enter the body by ingestion, by inhalation, by absorption through the skin, or by injection through a cut or break in the skin, such as a wound. • Inhalation – a major route of entry; either exhaled or deposited in the respiratory tract. If deposited, damage can occur through direct contact with tissue or may diffuse into the blood through the lung-blood interface. Substances absorbed into the blood are circulated and distributed to organs that have an affinity for that radioactive element. Health effects can then occur in the organs. • Ingestion –inadvertently gets into the mouth and is swallowed; can be absorbed through the lining of the gastrointestinal tract and then transported by the blood to internal organs. • DIRECT: in the plume drinking contaminated water • INDIRECT: eating meat from cattle that have fed on contaminated grass • Injection: Substances may enter the body if • Absorption – Skin (dermal) contact is the method of absorption into the body; can also cross the skin barrier and be absorbed into the blood system, producing systemic damage to internal organs; eyes are particularly sensitive to absorption. • Injection – Substances may enter the body if the skin is penetrated or punctured by contaminated objects. Effects can then occur as the substance is circulated in the blood and deposited in the target organs. Open wounds can also be a sources for injection. Examples: inhalation of airborne contaminants such as radon ingestion of contaminated food or liquids absorption of vapors such as tritium oxide through the skin injection of medical radioisotopes such as technetium-99m

21 Avoid Radioactive Contamination Do not: Use PPE and universal precautions while on the scene of or treating a patient from an • Eat incident involving radioactive material. • Drink • Smoke • Chew/Dip • Lip balm • Lipstick • Makeup

Contamination occurs when an individual comes in contact with radioactive material. This may be external, internal, or a combination of the two.

When people walk through, touch, or have radioactive material spill or fall upon them, they are externally contaminated. The contamination causes exposure because the radioactive material is deposited on the person’s body and/or clothing. Removing the clothing and showering with a mild soap will probably remove the external contamination. In stubborn cases, a second shower may be required.

A trained person with a survey instrument will be able to detect contamination on an individual and will be able to decontaminate them externally.

22 Contaminated Injured

Decontamination Protocols Saving lives

A contaminated individual may have also sustained a physical injury. In all cases, the treatment of an injury takes priority over decontamination.

Contamination is nothing more than a nuisance. Injuries come first, and decontamination comes second.

23 Radiation & Our Five Senses

• We are aware of our environment through our five senses.

• You must rely on instruments to detect the presence of radiation.

Ionizing radiation cannot be detected by our five (5) senses. We cannot feel, taste, smell, see, or hear radiation. The safety of emergency responders is the most important consideration when responding to a radiological incident. Safety is accomplished by the use of radiological instruments which help the first responder detect, measure, and document the amount of radiation in a radiological response. Therefore, we must use radiation detection instruments such as pocket dosimeters and other equipment to know if, when, and how much radiation is present.

You must learn to read the instruments properly because the instruments will let you know if radiation is present. You have to rely on them.

24 KI (Potassium Iodide) • Thyroid Blocking Agent

• Fills the thyroid gland with non- radioactive iodine

• Helps radioactive iodine from being absorbed into the thyroid

• Adult dosage: 130 mg/day – Effective for 24 hours

• Distributed at the Emergency Worker Station & the Community Reception Center by an ADPH nurse who is KI- trained

In a radiation emergency at a nuclear power plant, radioactive iodine in the form of I-131 may be released into the air. Potassium Iodide can help prevent radioactive iodine from being absorbed into your thyroid.

All radioactive material targets different parts of our bodies. Some are organ seekers, bone seekers, blood seekers, etc.. Radioactive iodine is a thyroid seeker. Our thyroid gland works like a sponge. We’re going to fill the thyroid gland up with nonradioactive iodine in the form of KI (Potassium Iodide). So if radioactive iodine happens to be breathed in, the thyroid gland is already full and would not accept much more, if any. So the radioactive iodine would be excreted from your body with minimal damage.

When there is a need for Potassium Iodide, KI will be made available to you. Potassium Iodide is stockpiled at the county health departments (Houston, Henry, Morgan, Lawrence, Lauderdale, and Limestone) in the possession of the county health nurse. If you are told to take KI, take 1 dose for every 24 hours (Daily dose = (1) 130 mg tablet or (2) 65 mg tablets) you are exposed to radioactive iodine. Do not take more often and do not take this drug if you know you are allergic to iodine.

25 Pocket Dosimeters

Roentgens

Roentgens 0 1.0 2.0 3.0 4.0 5.0 0 5 10 15 20

Milliroentgens 0 50 100 150 200 • Look through the dosimeter toward a light source

The Direct-Read Dosimeters (DRD) are designed to measure gamma radiation and x-rays. The DRD is a pencil-shaped tube with an eyepiece at the clip end and an ion-chamber equipped with a charging pin at the opposite end. Dosimeters are fairly accurate, rugged, and can be read directly by the user. Direct-Read Dosimeters give the advantage of immediately knowing the amount of gamma radiation that the wearer has been exposed to. DRDs are not expensive and are fairly easy to use.

The pocket dosimeter is read by pointing it toward a good source of light and viewing the scale and hairline through the lens at the clip end of the dosimeter. When reading pocket dosimeters, always keep the scale in the horizontal position to ensure an accurate reading.

If the dosimeter is exposed to radiation, the hairline will move along the scale to indicate the amount of exposure.

While performing the tasks of an emergency worker, read your dosimeter at least every 30 minutes. Record the beginning and ending dosimeter readings on the Radiation Exposure Record. The difference between the beginning and the ending is your exposure.

26 Radiation Exposure • Dosimeter = Odometer – It doesn’t go back down once it goes up. • Can be used by anyone else after it is zeroed. • Accumulated Exposure

Emergency workers measure their radiation exposure with a pocket dosimeter/direct-read dosimeter (DRD). Pocket dosimeters are a piece of equipment which can be read immediately by the wearer. Radiation exposure is measured in Roentgen (R) and Milliroentgen (mR). The pocket dosimeter will let you read how much dose you have received.

Pocket dosimeters are similar to odometers. The accumulated exposure recorded on a dosimeter can be compared to the accumulated distance on an odometer.

All emergency workers working in a radiation field will be issued two (2) pocket dosimeters. One (1) low-range dosimeter reading in 0-200 mR and one (1) high- range dosimeter reading in either 0-20 R or 0-5 R.

If your DRD is dropped (consider it contaminated) and the needle is no longer visible, then use the reporting levels from your team member. The use of another team member’s DRD reading is considered Group Dosimetry.

27 Thermoluminescent Dosimeter

Wearer Number • Records radiation dose for legal/permanent exposure records • Can not be used by anyone else once issued • Results not immediately available

The thermoluminescent dosimeter (TLD) is a laminated wallet-sized card which provides a permanent record of the wearer’s dose. TLDs are extremely accurate and will give the exact amount of exposure. The TLD card serves as your legal/permanent record to radiation.

TLD cards are so precise, they will give the exact amount of dose from radiation. TLDs contain two (2) lithium fluoride chips which absorb and store the energy received from exposure to radiation. Unlike the pocket dosimeters, TLD cards cannot be read directly by the user. When you complete your emergency worker duties, you will turn the TLD card in, your TLD will be sent off to be read, and you will be notified of your dose.

Remember: the thermoluminescent dosimeter serves as your legal/permanent record.

28 Placement of the TLD & Pocket Dosimeter

TLD Pencil/Pocket

TLDs and pocket dosimeters should be placed between the shoulder and the waist (preferably on the chest area).

Since TLDs cannot be read by the wearer, TLDs should be placed on street clothes or under protective clothing.

Pocket dosimeters need to be placed on the outside of the clothing whether it’s street clothing or protective clothing so they can easily be accessible when reading and reporting at predetermined time intervals (i.e. at least every 30 minutes).

29 TEDE (Total Effective Dose Equivalent)

• Total Dose = External + Internal • External = Pocket Dosimeter Reading • External = Internal • Therefore… • TEDE = 2 x Pocket Dosimeter Reading

In Alabama, the administrative limit is stated in terms of the external dose, which is measured by a pocket dosimeter. To account for the internal dose, which cannot be measured prior to or during a mission, the internal dose is assumed to be equal to the external dose. The two doses (internal & external) added together is the Total Dose or TEDE. In Alabama, twice (2x) the pocket dosimeter reading is recorded as a person’s TEDE.

30 Radiation Dosage Limits for Emergency Workers and Personnel & Equipment Monitors

Although emergency workers are not expected to be exposed to significant levels of radiation, the dosimeter reading values are shown in the right hand column. The administrative limit for emergency workers in Alabama is set at one-half of the EPA-recommended limits. This table shows the dosimeter readings that will most likely keep the TEDE (Total Dose) from exceeding the EPA limit. Do not exceed the limits in the right hand column, and you will not exceed your TEDE (Total Dose). The green wallet size card is for Emergency Workers (EWs) and Personnel & Equipment Monitors (PEMs). The 6 radiation dose limits apply to all EWs and PEMS. EWs and PEMs are instructed to seek relief at 100 mR on their dosimeter. Do not wait until the dosimeter is on 100 mR before you request relief. Remember, you are recording your dosimeters at least every 30 minutes. Call to request relief when your dosimeter approaches 100 mR; this gives your replacement ample time to travel to your destination to relieve you. ▪ Remember 100 mR on dosimeter (external) + 100 millirem (internal) = 200 mrem TEDE. ▪ Which dosimeter would you be reading? Answer: Low-range (black or silver) EWs and PEMs are allowed to receive 1 rem per day TEDE; your dosimeter would be reading 500 mR. ▪ 500 mR on dosimeter (external) + 500 millirem (internal) = 1000 mrem = 1 rem TEDE. ▪ Which dosimeter would you be reading? High-range (yellow) EWs and PEMs are allowed to receive 5 rem maximum per accident TEDE; your dosimeter would be reading 2.5 R. ▪ 2.5 R on dosimeter (external) + 2.5 rem (internal) = 5 rem TEDE. ▪ Which dosimeter would you be reading? High Range (yellow) The Annual Occupational Limit (AOL) for individuals who work in the radiation area are allowed to receive 5 rem per/year TEDE. Additional radiation dosage limits for EWs and PEMs: one could receive up to 25 rem TEDE for life saving situations. At that point your dosimeter should be reading 12.5 R. 12.5 R on dosimeter (external) + 12.5 rem (internal) = 25 rem TEDE.

31 Reminders for Emergency Workers and Personnel & Equipment Monitors

The back of the green wallet size card shows key reminders for both EWs and PEMs as well as key reminders for just PEMs.

Remember – You can carry/have the green wallet-sized card at all times. This green card lists all your limits and keynotes since you may not have access to the manual.

32 Emergency Worker Equipment

1. KI tablet a. When do you take the KI? (when your county EMA has instructed you to) b. How often and how many should you take? (one (1) 130 mg tablet or two (2) 65 mg tablets every 24 hours as needed) c. Who should not take KI? (a person who has a known medical history to iodine ) 2. Thermoluminescent Dosimeter (TLD Card) a. Can you read a TLD card? (No) b. What does the TLD card serve as? (Your legal permanent record) 3. Two Pocket Dosimeters. One low-range and one high-range. a. By color, which is the high range? (Yellow) b. What units are used by the high range dosimeter? (0-20 Roentgen) or (0-5 Roentgen) c. How often would you check and record your dosimeters? (at least every 30 minutes; Read 15 minutes in > 1 mR/hr field or every 30 minutes < 1 mR/hr field) d. What is your seek relief limit measurement on your dosimeter? (100 milliroentgen) e. Which dosimeter would you be reading to begin with? (Black or Silver - Low range, 0-200 milliroentgen) 4. Record your pocket dosimeter readings on the Radiation Exposure Record.

33 Milliroentgens Milliroentgens Milliroentgens 0 50 100 150 200 0 50 100 150 200 0 50 100 150 200

Reload dosimeter onto charger if: 1. Filament won’t move/appear 2. Filament “floats” (keeps on moving while Milliroentgens on the charger 0 50 100 150 200 Get a new dosimeter (or charger) if above cannot be resolved

Get a new dosimeter if 1. The filament still moves when off of the charger

Milliroentgens 0 50 100 150 200

Milliroentgens 0 50 100 150 200

34 CDV-750 Dosimeter Charger

Clamp Clamp Trigger

Discharge Button

Generator Lever

The dosimeter charger is used to charge or zero the pocket dosimeters with different lengths and ranges. The charger provides 200 volts to the direct-read dosimeter that moves the hairline down to zero.

Instructions on using the CDV-750 dosimeter charger: 1. Adjust the clamp to fit the length of the dosimeter. 2. Pull the clamp trigger back and insert the dosimeter with the clip toward the back. The dosimeter must have a snug fit. Make sure the scale of the dosimeter is horizontal. 3. Look to see if there is a hairline. If there is a hairline, pump the black generator lever to “charge” or zero the dosimeter. If you don’t have a hairline, then give the generator lever a few slow pumps, and the hairline will appear on the right hand side. Continue pumping the generator lever until the hairline is on zero. 4. If the hairline falls below zero, press the black discharge button to bring the hairline back to zero. 5. To remove the dosimeter from the charger, squeeze the clamp trigger and lift the dosimeter above the end of the clamp, pulling it straight back to disengage it from the charging contact. 6. Once removed from the charger, read the dosimeter to ensure that the hairline has remained on the zero reading. It may be necessary to re-zero the dosimeter.

35 EVERYONE TAKE THIS NOW!!!!!!! https://bit.ly/ADPHORCEW

EWs ONLY: 1. KEEP book 2. KEEP green card EVERYONE: 1. Turn in TLD 2. Turn in dosimeters 3. Turn in chargers

36 Radiological Guidance for Hospital Personnel

Radioactive materials are among the many kinds of hazardous substances emergency hospital personnel might have to deal with. It is prudent, as emergency personnel, to know your role in responding to such an accident should one occur in your community. Emergency hospital personnel should always follow procedures in order to handle radiation accidents properly.

37 Notification & Communication

When the hospital receives a call that a radiation accident victim is to be admitted, a planned course of action should be followed. The individual receiving the call should get as much information as possible and maintain good communication with the ambulance. Request the following information:

1. Number of accident victims 2. Each victim’s medical status and mechanism of injury 3. If victims have been surveyed for contamination 4. Radiological status of victims (exposed vs. contamination) 5. Identify the contaminant, if known 6. Estimated time of arrival 7. Call-back number

If any doubt about contamination exists, assume the victim is contaminated until proven otherwise. Advise ambulance personnel of any special entrance to the emergency department for the radiation victim. If the accident notification comes from a source other than the usual emergency communications, get a call-back number and verify the accident prior to assembling the radiological emergency response team and preparing for patient admission.

If during a drill, before each transmission, say “This is a Drill.”

38 Notification of State Radiological Authority

39 Basic Supply Requirements

In the event of a radiation emergency involving contamination, bring the following supplies to the corridor outside the decontamination area or to an adjacent room.

In some cases, a table or gurney is used and is set up outside the decontamination room with all supplies. This allows the outside nurse to remain in the area to record and document medical and radiological data while assisting the inside decontamination team with needed supplies.

40 Preparation of Radiation Emergency Area (REA) Contamination control is an important consideration during patient admission to ED

Cover floor between ambulance arrival area and REA

Be aware that plastic coverings can become slippery when wet

1. Select a treatment room near an outside entrance. Clear the area of visitors and patients. Remove or cover equipment that will not be needed during emergency care of the radiation accident victim. Survey instruments should be checked (record background levels) and ready to use prior to arrival of the patient. 2. Several large plastic-lined waste containers will be needed. The treatment table should be covered with several layers of waterproof, disposable sheeting. Plastic bags in all sizes will be needed and should be readily available. Rolls of brown wrapping paper, butcher paper, or plastic floor covering , three to four feet wide, can be unrolled to make a path from the ambulance entrance to the decontamination room. Ordinary cloth sheets or square absorbent pads can be used if paper is unavailable. Whatever floor covering is used, it should be taped securely to the floor. This route should then be roped off and marked to prevent unauthorized entry. The floor of the decontamination room or treatment area should be covered in a similar way, if time allows. This will make cleanup of the area easier. A control line should be established at the entrance to the decontamination room. A wide strip of tape on the floor at the entrance to the room or if available, a radiation step off pad, should be marked clearly to differentiate the contaminated (dirty) side from the non-contaminated (clean) side.

Steps to Controlling Contamination Ensure controlled area is large enough to hold patients Remove or cover non-essential equipment Cover floor areas Restrict access to controlled area Monitor everything leaving controlled area Use strict isolation procedures Control waste Use buffer zone for added contamination control Change out supplies as they become contaminated Use waterproof materials where possible

41 Ventilation and other concerns

• While it may be desirable that the room(s) have a negative pressure system that is separate from the rest of the hospital or a means of preventing the unfiltered exhaust air of the radiation emergency area from mixing with the rest of the hospital, there is very little likelihood that contaminants will become suspended in air and enter the ventilation system. Therefore, no special precautions are advised. • Decontamination table should be set up inside controlled area for patient decontamination • Standard treatment table • Burn table • Not all equipment can be decontaminated • Covering material with plastic or sheets will help prevent contamination • Porous materials such as straps on hospital carts should be discarded after use

42 Response Team Preparation Inside REA Outside REA • Team Coordinator • Administration • Physician • Public Information • Triage Officer Officer • Nurse • Security • Technical Recorder • Engineering • Radiation Safety Officer • Laboratory Tech • Survey/Monitor Assistant

Each member of this team should be familiar with the hospital’s written plan and should participate in scheduled drills. More frequent drills should be considered by subgroups as decontamination, triage, or radiological monitoring.
It is important that Radiation Emergency Response Team members be designated with a role.
Each team member plays a critical role in a successful response
The exact number of members will vary according to each facility and the nature of the incident Team Coordinator/Leader – Leads, advises and coordinates Emergency Physician – Diagnoses, treats, and provides emergency medical care Triage officer/Nurse – Assist physician with medical procedures, collection of specimens, radiological monitoring and decontamination; assesses patient’s needs and intervenes appropriately Technical Recorder/Outside Nurse – Records and documents medical and radiological data Radiation Safety Officer/Personnel - Monitors patient and area and advises on contamination and exposure control; maintains survey equipment Public Information Officer (PIO) – Releases accident information to public media Administrator – Coordinates hospital response and assures normal hospital operations Security personnel – Secures the radiation emergency area and controls crowds Environmental Services/Maintenance personnel – Aids in preparation of the radiation emergency area for contamination control Laboratory technician – provides routine clinical analysis of biological samples Radiology personnel – provides portal x-ray capabilities.

43 Radiation Patient Treatment Algorithm

Place on wall inside the decontamination room and review prior to the patient arrival. The REAC/TS algorithm will guide the treatment staff in assessing and treating the patient who is found to be contaminated by radioactive material.

24-Hour Emergency Phone: 865-576-1005 Ask for REAC/TS

Routine Work Phone: 865-576-3131

On the Web: https://orise.orau.gov/reacts

44 Patient Transfer

• Primary assessment is the initial, rapid assessment and treatment for life threats • Meet patient at ambulance entrance • Conduct rapid radiological survey for hazardous levels and of patient. Take survey of EMS and ambulance for release

The hospital staff will meet the ambulance outside the emergency department or designated receiving area. A victim in stable condition should immediately be transferred to clean stretcher. A whole body survey should be conducted prior to entering the decontamination room. The EMS personnel should remain with the ambulance.

Before leaving the area, the ambulance and personnel must be monitored for contamination. If contamination is found, a shower and change of clothing is required. A final survey by the hospital’s RSO is required before leaving the area. If the ambulance is found to be contaminated, the ambulance will be directed to the emergency worker decon station to be decontaminated. Contact your local county EMA for the locations of the emergency workers decon stations.

45 Patient Assessment and Triage

• Follow established local protocols and standards of care in providing patient care

• Local protocols and standards of care may need to be amended/modified to reflect care of contaminated patients

• Needs to be done by local jurisdiction/hospital medical staff

• Patient may have both radiological and non-radiological injuries/medical problems

Unstable Patient If it is determined that the patient is unstable and requires acute treatment, then he or she should be admitted to the Radiation Emergency Area (REA) and life- threatening injuries should be stabilized

Stable Patient Survey patient for contamination If contaminated, admit patient to REA and deliver medical, trauma care If not contaminated, admit to regular Emergency Department so this saves space in REA and reduces risk of patient contamination.

46 Removing Contaminated Clothing

Removing Contaminated Clothing: 1. Treat life-threatening problems first. Roll any sheeting TOWARDS the CONTAMINATION. 2. Prevent the spread of contamination, especially to the face. 3. Shoes are a likely source of contamination. Remove them using plastic to prevent contact. 4. Slowly cut the clothes from the head toward the feet. 5. Roll clothing, trapping the contamination in the clothing and rolled away from the patient’s skin. 6. Roll the patient protecting the cervical spine. Fold the sheet enclosing the clothing. 7. If possible, have the RSO survey the patient’s back while on his/her side after clothing has been removed. 8. Gently place all clothing and bedding in a trash bag marked for contaminated waste.

47 Sample Collection

• Substances that would normally be discarded should be saved

• Clinical and lab tests are used to assess the biological effects of radiation exposure • Isotope identification is very important when determining a course of treatment • Any samples taken should be placed in a sealed container and properly labeled

Types of Radiation Injuries

There are three types of radiation injuries that may be seen in the Emergency Department.

1. External only 2. External and/or Internal Contamination 3. Internal Incorporation

External Only .Easiest to remove and least harmful .80% of contaminant removed with clothing removal

Internal .Radioactive material ingested, inhaled, injected (impaled), or absorbed into body

Incorporation .Radioactive material taken into the cells, tissues, and organs

48 External Irradiation Only

External Irradiation • Occurs when all or part of the body is exposed to penetrating radiation (gamma/X-ray) from an external source • Exposure alone does not make patient radioactive • Irradiated patients present no radiological danger to care givers • Exposure can be to the whole body or localized

49 Contamination (External or Internal) • Occurs when the radioactive material is deposited on or ingested by the patient • A patient can be contaminated externally, internally, or both • Inhalation, ingestion, absorption, and injection are methods by which radioactive material can enter the body • Contaminated patients can present a radiological contamination hazard to care givers • Wear appropriate PPE

Prior to decontamination, remove the contaminated “dirty” sheet and survey using a radiological instrument the patient’s back for radioactive contamination.

Incorporation (Internal)

Internal Incorporation • Refers to the uptake of radioactive material into body cells, tissues, bones, and target organs such as the liver, thyroid, or kidney • Material distributed throughout the body based on its chemical properties • Can occur rapidly and is most difficult to remove

50 Wound Care for External Contamination

External Decontamination is a continuous cycle.

1. Survey the wounds for radioactive contamination. 2. Place an absorbent pad underneath the body to absorb the water/saline during decontamination. 3. To prevent the spread of contamination, drape the wound prior to applying water/saline. 4. Irrigate wound with water (room temp) or saline. 5. Pat dry (do not rub) wound. 6. Remove all drape and absorbent pads prior to resurveying. 7. If contamination levels are still twice background (2 x bkg), follow the steps above. 8. Remember to change gloves after handling patients or potentially contaminated equipment. 9. Avoid unnecessary activity in contaminated areas. 10.Avoid rough handling of contaminated clothes to minimize the creation of an airborne hazard. 11.Avoid touching unprotected skin areas while working with contaminated patients

REMEMBER: Consider everything contaminated unless proven otherwise. Use a pancake probe to determine if anything is contaminated or not.

51 Wound Injury

• Radioactive materials can enter wounds through several mechanisms: • Deposition by the object causing the wound • Deposition after wounding, such as a splash, spill, or spray • Blast injury • Crush injury • Challenging because the radioactive material may be imbedded in the wound • Survey open wounds with a covered probe • Gamma-emitting radioisotopes • Beta-emitting radioisotopes • Alpha-emitting radioisotopes • May require use of special wound probes

Wound Decontamination .Consider wounds contaminated until proven otherwise .Save dressings, drainage, and debrided tissue for isotopic analysis .A wound with plutonium contamination (or other alpha-emitting material) is difficult to detect .Specialized probes must be used .Following decontamination, all wounds should be covered to prevent cross contamination from other area

Lacerations .Irrigate with water or saline to remove most of the contamination .Hydrogen peroxide or Betadine scrubs of wound may be necessary .Jagged edges of wound may be difficult to fully decontaminate .Expert consultation should be sought prior to debridement

Foreign Bodies . Treat as any suspected foreign body .Save for later analysis (place in a leaded container) .Shrapnel from radiological dispersal device or other radioactive source may be highly radioactive and should be surveyed by trained personnel

Orifices – Mouth or Nose .Sample with swabs under tongue and between gums .Use a separate moist swab for each nostril. Label each sample from which nostril .Blow nose gently .Saline lavage: Head forward, keep saline out of mouth, pharynx - High likelihood of swallowing .Remove any foreign objects .For mouth, brush teeth, gargle, rinse mouth and spit. AVOID SWALLOWING

52 A Guide to Decontaminate Intact Skin

1. Removing clothing will remove majority of contamination 2. Sample contaminated areas with moistened gauze or swabs 3. Isolate contaminated area with waterproof drapes 4. Use least aggressive method for decontamination so as not to abrade the skin a. Use 4x4 for small areas b. Irrigate with lukewarm water c. Gently scrub skin with soap an\d warm water d. Use bleach diluted 10:1 on intact skin e. Use cornmeal/detergent mix on calloused areas 5. Decontamination is a repetitive process

Detecting Internal Contamination

• To rapidly detect internal contamination and/or incorporation, check for one or more of the following: • History of splash/spray, etc. with radioactive material • Contamination in or near portals of entry—mouth, nose, wounds, etc. • Contamination found in emesis, sputum, urine, feces, saliva etc • Not finding contamination in initial sputum or urine does not rule out the presence of internal contamination

The following methods take longer to detect internal contamination/incorporation using the samples collected: . 24-hour urine and feces collections . Repeat sputum collections . Whole body counting . Symptoms of toxicity from the radioactive material, such as heavy metal poisoning from uranium or plutonium, can be detected

53 Treatment for Internal Contamination

• Three basic strategies for the removal of internally contaminating radioisotopes are to: 1. Decrease absorption from gut 2. Dilute isotope and block incorporation 3. Administer mobilizing agents

1. Decrease Absorption from Gut

• Decrease absorption from the gut • Gastric lavage - timing, forcing through pylorus • Barium sulfate - radium and strontium • Al and Mg salts - decreases absorption of radium and strontium • Prussian blue - cesium, thallium • Included in the Strategic National Stockpile • PH adjustment - changes solubility of some compounds

54 2. Dilute Isotope and Block Incorporation

• Isotopic dilution • Administering large amounts of the stable isotope of the same element to increase excretion of radioisotope • Works well for tritium • Water, IV fluids, other oral fluids • Maintain copious urine output • Block incorporation • Saturate the target tissue/organ with the stable isotope to reduce uptake of the radioisotope • Radioiodine is the prototype for use

3. Mobilizing Agents

• Mobilizing agents • Chemicals that enhance elimination of the radioisotope from the body • Chelation (EDTA, DTPA, etc.) for heavy metals/transuranics • Diuretics used to increase excretion of electrolytes

55 Discharging the Patient

• Following decon, thoroughly survey patient • Replace gurney sheets • Transfer patient to a clean stretcher with the help of “clean” assistants • Have RSO perform final check of patient and stretcher before removing stretcher from REA • After final approval, wheel patient out of the REA • Alternate lateral transfer to a clean gurney may also be used

Patient decontamination is just one step in the decontamination process. Following decontamination, the patient and staff still need to exit the REA.

A final survey should be conducted prior to leaving the decontamination room. Remove the sheets and replace with a clean sheet to be used to transfer the patient to a clean stretcher. While the patient is rolled, conduct a final survey of the back.

56 Patient Movement out of REA

1 2

3 4

When contamination levels have been reduced to below twice background (<2 x bkg) and patient’s injuries have been assessed, the patient should exit the decontamination room. To prevent cross contamination, a strip of craft/butcher paper should be placed on the decontamination room floor to allow the entry of the clean stretcher. The patient should then be transferred to the clean stretcher. Prior to exiting the decontamination room, RSO or designee should survey the stretcher wheels for contamination.

57 Exit of Hospital Personnel

• Carefully remove protective clothing at control line • Protective clothing should be removed in a step-by- step process. Follow the doffing instructions • Step across control boundary once protective clothing is removed and perform a total-body survey • Take a shower and redress in normal attire

Each decontamination room personnel will take their turn in properly removing the anti-C clothing while exiting the decontamination room. To properly remove the anti- C clothing and equipment and to eliminate unnecessary cross contamination, follow the “Radiation Accident Protocol Exit of the Decontamination Team” poster.

Please note: If personnel needs assistance with removal of coveralls, etc, assistance can be given but make sure that clean latex gloves are worn. Also, to assist with balance, a metal non-fabric chair should be used.

Once each decontamination room personnel has completely exited the decontamination room, the RSO will conduct a total-body survey to verify no contamination is present. If contamination is found, the personnel will be instructed to remove their clothing and shower with a mild soap and shampoo and return to be resurveyed.

58 Final Close Out of REA To close out the REA, everything must be surveyed to ensure it is not contaminated and then decontaminated if necessary Decontamination of equipment can be very technical and a licensed contractor should be consulted.

Consult with law enforcement before initiating cleanup actions if incident was the result of a terrorist or criminal act— evidence preservation. Who is responsible for cleanup costs?

59 Radiation Emergency Assistance Center/Training Site (REAC/TS)

The REAC/TS RadMed App includes… • Updated eGuide for The Medical Aspects of Radiation 24-Hour Emergency Phone: Incidents • Basic health physics and dose estimation (US and SI 865-576865-576-1005-1005 Units) • Treatment of whole body and acute local radiological Ask for REAC/TS illnesses and injuries • Assessment and treatment of internal contamination with radioactive materials • Patient decontamination Normal Work Hours Phone: • Delayed effects of exposure to ionizing radiation • Risk and psychological issues 865-576-3131 • Dicentric chromosome assay (DCA) • State, federal and international resource database • Assessment tools for radiation incident preparedness • REAC/TS courses On the Web: orise.orau.gov/reacts • REAC/TS videos • Real-Time REAC/TS news • Links to partner resources Search for “REAC/TS”

The REAC/TS staff are available 24 hours a day/seven days a week to deploy and provide emergency medical consultation for incidents involving radiation anywhere in the world. REAC/TS is recognized for its expertise in the medical management of radiation incidents.

https://bit.ly/adphorchmpreview

HMPs ONLY: 1. Fill out feedback form 2. KEEP book 3. KEEP green card

60 Radiological Survey Meter(s) Ludlum 14C

The Ludlum 14C survey meters are highly sensitive broad range radiation detectors.

The Ludlum 14Cs may have two probes. The “pancake” probe (Ludlum 44-9) is used to survey for radiation contamination. The HP “hotdog” probe (Ludlum 44-38) is used to measure radiation exposure rate. The broad range of the Ludlum 14C is 0 – 6,600,000 cpm or 0 – 2,000 mR/hr.

The Ludlum 14C can detect radiation contamination and discriminate between beta and gamma radiation. When using the pancake probe, face the window toward the equipment/personnel being surveyed, thus the Ludlum 14C will detect both beta and gamma radiation. By flipping the probe over and facing the window away from the equipment/personnel being surveyed, the Ludlum 14C will detect gamma radiation only.

When using the hotdog probe with the shield open, the Ludlum 14C will detect beta and gamma radiation. By closing the shield, the Ludlum 14C will detect gamma radiation only.

61 Pancake Probe Ludlum 14C CPM

Response

Scale Probe Audio Connector

Reset Battery Check Multiplier Switch Battery Compartment

Parts of the Ludlum 14C: 1. Response Switch – Turn to the “F” position for a fast response. 2. Audio Switch – Turn to the “ON” position to hear the clicks. 3. Reset Button – Press this button when you change the multiplier switch for the meter to read a different scale. 4. Battery Check Button – Press this button to ensure batteries are good. The hairline will peg to the “BAT Test” or “BAT OK” area on the scale. 5. Scale – Use the top scale when monitoring for contamination (CPM). Use the middle scale when measuring dose rate when the meter is set on the X0.1, X1, and X10. And use the bottom scale when measuring dose rate when the meter is set on the X100 and X1,000. 6. Probe connector – Connect cable to probe connector and the probe. 7. Multiplier Switch – A 6-position switch marked OFF, x1000, x100, x10, x1, x0.1. Always set switch at X0.1 to check background and to monitor for contamination. 8. Battery compartment – Two “D” size batteries.

62 Radiation Contamination

• Survey Meter = Speedometer – It can go up and down.

– Look for a sustained reading. 0-6,600 CPM Pancake Probe Only Use Top Scale (Counts per minute a. k. a. CPM)

A contamination reading from a survey meter can be compared to the rate of speed registered on an automobile speedometer. A speedometer tells us our rate of speed in miles per hour.

We can use a survey meter to determine if radioactive contamination is present. Radioactive contamination is measured in COUNTS PER MINUTE (CPM) and can be measured with a survey meter such as a Ludlum 14C (top scale).

The face plate of the Ludlum 14C has three (3) scales and a hairline. The top scale is used when monitoring for contamination. The middle scale is used for measuring exposure rate. The bottom scale is also used for measuring exposure rate but only when the multiplier switch is in the X100 or X1,000 position.

Contamination is always measured in CPM (Counts Per Minute). Use the pancake probe (44-9) for contamination survey. Always start on the lowest scale of X0.1.

NOTE: With the dial set on the X0.1 (lowest), the CPM scale is reading 0-600 CPM. Dial set on X1, the CPM scale reads 0-6,000 CPM. Dial set on X10, the CPM scale reads 0-60,000 CPM. Dial set on X100, the CPM scale reads 0-600,000 CPM. Dial set on X1000, the CPM scale reads 0-6,000,000 CPM.

63 Radiological Survey Meters

• Patient care should not be delayed due to detailed surveys • Many hospitals have a nuclear medicine department that can act as a resource • Survey instruments can: • Easily and accurately measure radiation and contamination – Twice background radiation • Help evaluate radiological hazards

The Ludlum 14C survey meters are highly sensitive broad range radiation detectors. The Ludlum 14Cs may have two probes. The pancake probe is used to survey for radiation contamination. The HP probe (hotdog) is used to measure radiation dose rate. The broad range of the Ludlum 14C is 0 – 6,600,000 cpm or 0 – 2000 mR/hr. The Ludlum 14C can detect radiation contamination and discriminate between beta and gamma radiation. With the window facing the equipment/personnel being surveyed, the Ludlum 14C will detect beta and gamma radiation. By flipping the probe over and face the window away from the equipment/personnel being surveyed, the Ludlum 14C will detect gamma radiation only.

Some hospital’s nuclear medicine departments may use and have different but similar radiation detection survey meters. Keep in mind that radiation contamination is measured in counts per minute (cpm) or counts per second (cps). It is also ideal if the radiation instrumentation has the ability to measure exposure rate. Whatever instrument you have, make sure that it is within the yearly calibration. Also prior to monitoring, verify the response of the meter with the check source, check batteries, and properly set up the instrument.

64 Ludlum 14C Scale(s)

0-6,000 (6K) CPM Pancake Probe

0-2.0 mR/hr HP Probe 0-2.0 mR/hr Hairline Use on X100 only HP Probe

The face plate of the Ludlum 14C has three (3) scales and a hairline. The top scale is used when monitoring for contamination .The middle scale is used for measuring exposure rate. The bottom scale is also used for measuring exposure rate but only when the multiplier switch is in the X100 position.

Contamination is always measured in CPM (Counts Per Minute). Use the pancake probe (44-9) for contamination survey. Always start on the lowest scale of x0.1.

NOTE: With the dial set on the X.1 (lowest), the CPM scale is reading 0-600 CPM. Dial set on X1, the CPM scale reads 0-6,000 CPM. Dial set on X10, the CPM scale reads 0-60,000 CPM. Dial set on X100, the CPM scale reads 0-600,000 CPM. Dial set on X1000, the CPM scale reads 0-6,000,000 CPM.

65 Radiation Detection Equipment

Radiation Safety Officer (RSO) should issue dosimetry to all emergency medical personnel working in the decontamination area and record information on the Radiation Equipment Distribution Log. Radiation Exposure Record should be kept for each emergency medical personnel in order to keep track of radiation exposure.

66 Ludlum 14C What is the Meter Reading? 240 CPM

Ludlum 14C What is the Meter Reading? 40 CPM

67 Ludlum 14C What is the Meter Reading?

66,000 CPM

Ludlum 14C What is the Meter Reading? 3,700 CPM

68 Ludlum 14C What is the Meter Reading?

OFF-SCALE: Need to change “Multiplier Switch” to x1. Check cable and batteries “RESET” button.

Ludlum 14C What is the Meter Reading? 260,000 CPM

69 Ludlum 14C What is the Meter Reading? 25,000 CPM

Ludlum 14C What is the Meter Reading? 5,200 CPM

70 Ludlum 14C What is the Meter Reading?

70,000 CPM

Ludlum 14C What is the Meter Reading?

140 CPM

71 Techniques for Monitoring for Contamination

• Locating contamination on personnel and equipment. • Determining the effectiveness of decontamination • Verifying contamination control boundaries • Determining the extent and magnitude of patient contamination • Establish a method or pattern for surveying and pay close attention to portals of entry • Hold open probe 1 inch from surface and move at a rate of 1 inch per second • Note any contamination found on the appropriate form • Contamination in Alabama is twice (2x) background radiation.

72 Survey Meters: Monitoring for Contamination • Ludlum 14C – Use 44-9 “Pancake” Probe – Open windows • Hold probe 1 inch away • Start at the head – Move probe 1-2 inches per second • Always monitor “top-side” – Avoid having the meter face upward to prevent contamination from falling onto probe • Remember soles of feet • Survey thyroid gland – Closed window • Contamination ◦ 2 X background

Monitoring for contamination using a Ludlum 14C:

1. Using the pancake probe, face the window toward the equipment/personnel. 2. Start at the top of the head. 3. Hold pancake probe 1 inch away. 4. Move at a rate of 1-2 inches per second. 5. Pay close attention to the hair and soles of the shoes. 6. When contamination is detected, record on a personnel/monitoring record where the contamination was found. 7. Survey thyroid gland with the probe closed window. NO LONGER PERFORMED

NOTE: If the hairline reaches the max amount, step away from the person, switch the dial to the next position, push the reset button then continue monitoring. Repeat steps if needed. Once contamination is no longer present in that area and has been recorded on the personnel/monitoring record, remember to turn the scale back to the lowest scale and continue the survey.

Typical background radiation using a Ludlum 14C is 50 cpm. Twice background radiation warrants decontamination.

73 Ludlum 14C Surveying the Thyroid Gland

• Probe closed window • Place probe

Backside of pancake –1 inch away probe 1 inch away –Adams Apple from Adams Apple • Multiply count rate by .04 • Thyroid uptake limit (5 rem)

NO LONGER PERFORMED Monitoring the thyroid: 1. Place the back of the pancake probe (window face away from the personnel or metal side facing the personnel) 1 inch away from the Adam’s apple. 2. Multiply the meter reading by .04 to determine the thyroid uptake in rem. 3. Thyroid uptake limit is 5 rem.

If the thyroid uptake is ≥5 rem, then additional internal monitoring should be conducted by the appropriate medical department.

Radiation Dosage Limits for Personnel & Equipment Monitors

SAME AS GREEN CARD Although personnel & equipment monitors are not expected to be exposed to significant levels of radiation, dosimeter reading values are shown in the right hand column.

These are the same limits as the emergency workers (Green Card). 74 Thyroid Uptake Limits

MOVED TO GREEN CARD The back side of the Personnel & Equipment Monitors “yellow card” is different.

Listed at the top are key reminders that a personnel & equipment monitor needs to remember when dealing with radiation.

Listed at the bottom are instructions on determining the uptake of radioactive iodine in rem. A check of the thyroid gland can be made by holding the probe (shield closed) in a horizontal position just below the Adam’s apple. And using the Ludlum 14C, the count rate in excess of background and surface contamination multiplied by .04 is assumed to be due to thyroid uptake. The thyroid uptake limit is 5 rem.

75 Reminders for Personnel & Equipment Monitors

The back of the green wallet size card shows key reminders for both EWs and PEMs as well as key reminders for just PEMs.

Remember – You can carry/have the green wallet-sized card at all times. This green card lists all your limits and keynotes since you may not have access to the manual.

76 Safety Briefing •Equipment •Dose limits •PPE

PARTIAL SAFETY BRIEFING (see full one at back of book)

All Emergency Workers will be issued the following equipment: • Radiation Exposure Record • Thermoluminescent Dosimeter (TLD card) o Fill out Radiation Exposure Record information • Low Range Pocket Dosimeter (0-200mR): black or silver o Fill out Radiation Exposure Record information • High Range Pocket Dosimeter (0-20R): yellow o Fill out Radiation Exposure Record information • Maximum Radiation Dosage Limit Card (green card) • Potassium Iodide (KI) will be issued by ADPH KI Nurse. DO NOT TAKE UNTIL TOLD TO DO SO BY EMA.

• When reading your dosimeter, point toward a good light source. Read through the clip end. Keep the scale in the horizontal position to assure an accurate reading. • Read your dosimeters every 30 minutes, and record on your radiation exposure record. • The TLD card is your permanent record and cannot be read in the field. • Read your dosimeters and record on the Radiation Exposure Record at least every 30 minutes. o Seek relief at 100mR (black dosimeter) o Do not wait until the dosimeter is on 100mR before requesting relief; call when it’s approaching 100mR. • Your TLD and dosimeters should be worn in your black pouch on the outside of your clothing. • If you reach the limit on your black low range dosimeter (200mR), use your yellow high range dosimeter (20R). • Authorization to exceed emergency worker exposure guidelines must be obtained from the State Health Officer prior to any exposure limit being exceeded. This will be done through the local EMA office. • Remember to stay in contact with your department’s safety officer. • If you have any questions, contact the local EMA office for assistance.

77 Ludlum 14C-Set Up & Operation

Before any possibly contaminated individuals arrive at the reception center, check the operation of the survey meter and record background radiation at that location. Then follow the steps below:

1. Verify annual calibration due date has not expired. 2. Conduct a physical inspection of meter. 3. Turn the multiplier switch to the “Off” position. 4. Turn toggle switches to “AUD ON” and to “FAST RESPONSE.” 5. Open battery compartment beneath handle and install 2 D-cell batteries. 1. Correct polarities are engraved on inside of lid. (+) should touch the positive side of battery. (-) should touch the negative side of the battery. 6. Connect cable to unit and a pancake (44-9) probe. Remove protective cover from probe. 7. Turn Multiplier Switch to lowest scale (X0.1) and press and hold “BAT” button. Needle should deflect to “BAT OK” or “BAT TEST.” 8. Open the source window and place open probe against source while looking for visual needle deflection and listening for an audible sound. Then remove the probe from the source. This is a “response check.” 9. Turn toggle switches to “AUD OFF.” 10. Place open probe against source for visual needle deflection, then scale up with Multiplier Switch until a steady reading is obtained that is not off-scale. This is a “calibration check.” a. Each probe shall read within +/- 20% of the reference reading found on the calibration sticker. 11. Cover probe with plastic wrap, non-freezer plastic bag, or latex/nitrile glove. This prevents the probe from being contaminated. If using bag, secure to probe tightly using rubber band to ensure nothing is hanging down. If using glove, fold back fingers and tape down toward handle. 12. Turn toggle switches to “AUD ON” and to “SLOW RESPONSE.” Close source windows. Change multiplier switch to X0.1 and press “RESET.” 13. Take a background radiation reading with probe open window (X0.1 position) using the pancake probe (44-9). Average background using a Ludlum is typically 50 counts per minute (cpm). 14. Turn toggle switch to “FAST RESPONSE.” 15. For problems, contact the local EMA.

*Follow instructions attached to Ludlum for reference

78 Ludlum 14C Just in Time Website

http://bit.ly/ludlum14cjit

1. Assembly instructions (PDF) 2. Assembly video (00:00)

https://bit.ly/adphfeedback

1. Fill out feedback form 2. Return survey meter to container. 3. KEEP book 4. KEEP green card

79 Glossary

• ALPHA RADIATION – A positively charged particle emitted from the nucleus of a radioactive element. It has a low penetrating power and has a short range - a few inches. Alpha particles are not an external hazard but are extremely hazardous when introduced into the body.

• ALARA – An acronym for As Low As Reasonably Achievable. An approach to radiation protection to control or manage exposures as low as social, technical, economic, practical, and public policy considerations permit. ALARA is not a dose limit but a process to keep dose levels as far below applicable limits as reasonably achievable.

• BACKGROUND RADIATION – The radiation in the natural environment, including cosmic rays and radiation from the naturally radioactive elements, both outside and inside the bodies of humans and animals. It is also called natural radiation. The average individual exposure from background radiation is 620 millirem per year.

• BETA RADIATION – A negatively charged particle emitted from the nucleus during radioactive decay. It has a medium penetrating power and a range of up to a few feet. Large amounts of beta radiation may cause skin reddening, and are harmful if they enter the body. Beta radiation is an external and internal hazard.

• CONTAMINATION – The deposition of unwanted radioactive material on the surface of structures, areas, objects, or personnel. Radioactive material in a location where it is unwanted.

• CPM – An acronym for counts per minute and is associated with contamination surveys. The pancake probe (44- 9) with the Ludlum 14C is used when detecting for contamination.

• DECONTAMINATION – The reduction or removal of radioactive material from a location where it is unwanted.

• DOSIMETER – A portable instrument or device used for measuring and registering the total accumulated exposure to ionizing radiation. Examples are pocket dosimeter, TLD or film badge.

• EMERGENCY CLASSIFICATION Levels – 1. Notification of an Unusual Event (NOUE), 2. Alert, 3. Site Area Emergency, 4. General Emergency.

Glossary • EMERGENCY WORKER – An individual performing duties to protect the health and safety of the public during a radiological emergency (e.g., firemen, school bus driver, police, highway personnel, medical personnel, etc.)

• EXPOSURE – The absorption of radiation or ingestion of a radionuclide.

• EXPOSURE RATE – The measure of radiation by a device (survey meter) over some time period, usually an hour.

• GAMMA RADIATION – A high energy photon emitted from the nucleus of an atom. It has the most penetrating power and a range of up to hundreds of feet. Gamma rays will penetrate the internal organs, therefore, they are an internal and external hazard.

• GEIGER-MUELLER COUNTER – A radiation detection and measuring instrument. It consists of a gas-filled tube containing electrodes, between which there is an electrical voltage but no current flowing. When ionizing radiation passes through a tube, a short intense pulse of current passes from the negative electrode to the positive electrode and is measured or counted. The number of pulses per second measures the intensity of radiation.

• ION – An atom that has too many or too few electrons, causing it to be chemically active; an electron that is not associated (in orbit) with a nucleus.

• IONIZING RADIATION – Any radiation capable of displacing electrons from atoms, thereby producing ions. Examples: alpha, beta, gamma, x-rays, neutrons and ultraviolet light. High doses of ionizing radiation may produce severe skin or tissue damage.

• INVERSE SQUARE LAW – The law states the gamma rays intensity is inversely proportional to the square of the distance from a point source. Therefore, doubling the distance from a point source of gamma radiation decreases the exposure rate to one-fourth (1/4) the original exposure rate.

80 Glossary • IONIZATION – The process of adding one or more electrons to, or removing one or more electrons from, atoms or molecules, thereby creating ions. High temperatures, electrical discharges, or nuclear radiation can cause ionization.

• LITHIUM FLUORIDE – A chemical compound used in thermoluminescent dosimeters.

• KCPM – An acronym for kilo counts per minute (thousands of counts per minute).

• MILLI – A prefix meaning one-thousandth (1/1000) or divides a basic unit by 1000. For example, millirem is one-thousandth part of a rem )

• PERSONNEL MONITORING EQUIPMENT– Devices designed to be worn by a single individual for the assessment of dose equivalent such as film badges, thermoluminescent dosimeters (TLDs), and pocket dosimeters.

• POTASSIUM IODIDE (KI) – A chemical form of stable iodine that can be used by the body to block absorption of radioiodine by the thyroid gland.

• RAD – An acronym for Radiation Absorbed Dose . The special unit of absorbed dose. One (1) rad is equal to an absorbed dose of 100 ergs/gram or 0.01 joule/kilogram (0.01 gray).

• RADIATION – Is energy in the form of rays or high-speed particles. Radiation occurs naturally as in sunlight. Radiation is also manmade in the form of x-rays, medical treatments, nuclear weapons, and commercial nuclear power facilities. All forms of electromagnetic radiation make up the electromagnetic spectrum.

• RADIOACTIVE MATERIAL – Any material which spontaneously emits particle or photon radiation in an effort to expend excess energy.

• RADIOACTIVITY – The spontaneous emission of radiation, generally alpha or beta particle often accompanied by gamma rays from the nucleus of an unstable isotope.

Glossary • RCA – An acronym for Radiation Control Agency.

• REM – Roentgen Equivalent in Man. The special unit of dose equivalent in man. It is measurement of the effect of all types of radiation on the human body.

• ROENTGEN (R)– A unit of exposure to ionizing radiation in air. It is radiation effect in air from x-rays or gamma rays.

• SHIELDING – Any material or obstruction that absorbs radiation and thus tends to protect personnel or material from the effects of ionizing radiation

• SURVEY METER – Any portable radiation detection instrument adapted for inspecting an area to establish the existence and amount of radioactive material present.

• TEDE – An acronym for Total Effective Dose Equivalent. Total Dose = External Dose + Internal Dose.

• THERMOLUMINISCENT DOSIMETER (TLD) – An extremely accurate device used to measure and provide a permanent record of exposure to radiation.

• X-RAY – A photon originating from the electron cloud rather that from the nucleus of an atom. One form of electromagnetic radiation. It has penetrating power like gamma radiation. X-rays will penetrate the internal organs, therefore, they are an internal and external hazard.

81 Just In Time Videos • Pocket Dosimeter Zeroing: Using CDV-730 Charger (quick overview) – https://youtu.be/0yxneFuqDQE

• Pocket Dosimeter: Usage of Low & High Range Dosimeters – https://youtu.be/Nez1_pi_8z4 – Note: Although many protocols in the video are in line with ADPH protocols, always follow ADPH protocols

• Donning PPE (ADPH-produced) – https://youtu.be/UANQNAd1a4c

• Doffing PPE (ADPH-produced) – https://youtu.be/MNU6uaIdNQA

Just In Time Videos • Survey Meter: Ludlum 14C (overview only) – https://youtu.be/Im16jXwxRP0 – Note: Follow ADPH Just In Time training sheet for instructions of assembly & ADPH protocols for monitoring

VIDEOS FOR YOUR MODEL OF DIGITAL ALARMING DOSIMETER COMING SOON (where applicable).

82 Name: SS# (last 4): 200 mR ( )5R ( ) 20R Agency: DOS#: Date: (MM/DD/YY) TLD#: Note! Read dosimeter at least every 30 minutes 06/2019 Reading Status () # Time (24 hr) Low Range (mR) High Range (R) Start End Total

1 Initial Reading 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

83 # Date (MM/DD/YY): Name: Dosimeter(s) TLD Card SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading

# Date (MM/DD/YY): Name: Dosimeter(s) TLD Card SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading

# Date (MM/DD/YY): Name: Dosimeter(s) TLD Card SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading

# Date (MM/DD/YY): Name: Dosimeter(s) TLD Card SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading

# Date (MM/DD/YY): Name: Dosimeter(s) TLD Card SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading

# Date (MM/DD/YY): Name: Dosimeter(s) TLD Card SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading

# Date (MM/DD/YY): Name: Dosimeter(s) TLD Card SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading

# Date (MM/DD/YY): Name: Dosimeter(s) TLD Card SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading

84 RADIATION ACCIDENT TEAM DRESS-OUT PACKAGE

ITEM QUANTITY Disposable Coveralls 1 (pair) Disposable Booties 1 (pair) Disposable “Orange” Nitrile Gloves 1 (pair) Disposable Non-latex Gloves 1 (pair) Yellow Plastic Waterproof Shoe Covers 1 (pair) Disposable Hood 1 Protective Mask w/Splash Visor Eye Shield 1

Note: You will need a roll of masking tape.

DRESS-OUT INSTRUCTIONS

1. Record your TLD card and personal dosimeter serial number and reading on the RSO’s log sheet before you enter the controlled area.

2. Attach TLD to clothes (upper body).

3. Put on disposable booties.

4. Put on (Yellow) plastic waterproof shoe covers over the disposable booties.

5. Put on disposable coveralls (tape zipper & tape to booties- leave a tab for easy removal of tape).

6. Put on inner pair of “Orange” nitrile gloves (tape to sleeve - leave a tab for easy removal of tape).

7. Put on outer pair of non-latex gloves (do not tape).

8. Label your position “title” on masking tape (place on front and back of coveralls).

9. Attach pocket dosimeters to upper body (outside coveralls).

10. Put on mask w/splash visor eye shield.

11. Put on disposable hood.

Last Revised: January 2020

85 RADIATION ACCIDENT PROTOCOL EXIT OF THE DECONTAMINATION TEAM

(Post in sight of step-off pad)

1. Have Inside Radiation Safety Officer (RSO) frisk hands before beginning Exit Process. If contamination is found remove and replace outer pair of non-latex gloves and continue instructions.

2. Give pocket dosimeter to RSO. Be sure that reading is recorded upon exit.

3. Remove disposable hood and put in a waste container.

4. Remove (Yellow) plastic waterproof shoe covers and put in a waste container.

5. Remove tape from wrists, coveralls, and booties and put them in a waste container.

6. Remove coveralls (slowly pull downward to ankles). Step out of coveralls and put in a waste container.

7. Remove disposable booties (one at time) and put in a waste container while stepping over the control line (RSO should monitor bottom of shoes at this time).

8. Remove outer pair of non-latex gloves and put them in a waste container.

9. Remove TLD and give to RSO.

10. Remove mask w/splash visor eye shield and put in waste container

11. Remove inner pair of “Orange” nitrile gloves and put them in a waste container.

12. Receive a complete whole-body survey with a Geiger Mueller survey meter from the hospital personnel (should take several minutes).

13. If survey indicates the presence of contamination, DO NOT leave the area until assisted by the RSO.

Last Revised: January 2020

86 87 88 Equipment/supplies needed for “Just in Time Training”: Thermoluminescent Dosimeters (TLD cards) Clips for TLD Cards Low Range Pocket Dosimeters (0-200 mR) High Range Pocket Dosimeter (0-5 R or 0-20 R) CDV-750 Dosimeter Charger(s) Radiation Dosage Limits Cards for Emergency Workers and Personnel & Equipment Monitors Radiation Equipment Distribution Log(s) NOTE: Record all EWs and PEMs with the appropriate issued equipment. Radiation Exposure Record(s) Pen(s) and/or Pencil(s)

All EWs and PEMs will be issued the following equipment (pouches): 1. Thermoluminescent Dosimeter (TLD Card) 2. Low Range Pocket Dosimeter (0-200 mR) 3. High Range Pocket Dosimeter (0-5 R or 0-20 R) 4. Radiation Exposure Record 5. Radiation Dosage Limit Card 6. Potassium Iodide (KI) will be made available, if needed (EWs only)

Follow the steps below to conduct “Just in Time” Training: Zero pocket dosimeters (instructions on back) Track each EW and PEM issued dosimetry on the Radiation Equipment Distribution Log Prepare a Radiation Exposure Record for each EW and PEM Instruct each EW and PEM on the use and specific details of dosimetry (see below) Inform each EW that Potassium Iodide (KI) will be made available, if needed (EWs only) Issue each EW and PEM a Radiation Dosage Limit Card and discuss the allowable limits Remember: TIME, DISTANCE and SHIELDING! At the end of mission, return dosimetry, etc. to the Command Post and/or EW station. Dosimetry will be recorded. (EWs only) If contamination is present, EWs will be directed to a local community reception center for decontamination. (EWs only)

 TLD card(s) serve as a permanent/legal  Pocket dosimeters can be read directly by the user record.(user specific; not interchangeable)  Place pocket dosimeters on the outside of the top  Place clip on TLD card layer of clothing between the neck and waist  Clip TLD card to street clothes or under (preferably chest area) protective clothing between the neck and waist  Read both (low and high) pocket dosimeters at least (preferably chest area) every 30 minutes (clip end/good source of light)  Can NOT be read in the field; will be read at the  Record readings on the Radiation Exposure Record completion of the emergency  Seek relief at 100 mR on the low dosimeter

89 Radiation Dosage Limits: Emergency Workers Personnel & Equipment Monitors

Instructions on how to zero a pocket dosimeter

1. Adjust the clamp to fit the length of the dosimeter. 2. Pull the clamp trigger back and insert the dosimeter with the clip toward the back. The dosimeter must have a snug fit. Make sure the scale of the dosimeter is horizontal. 3. Look to see if there is a hairline. If there is a hairline, pump the black generator lever to “charge” or zero the dosimeter. If you don’t have a hairline, then give the generator lever a few slow pumps, and the hairline will appear on the right hand side. Continue pumping the generator lever until the hairline is on zero. 4. If the hairline falls below zero, press the black discharge button to bring the hairline back to zero. 5. To remove the dosimeter from the charger, squeeze the clamp trigger and lift the dosimeter above the end of the clamp, pulling it straight back to disengage it from the charging contact. 6. Once removed from the charger, read the dosimeter to ensure that the hairline has remained on the zero reading. It may be necessary to re-zero the dosimeter.

90 LUDLUM 14C GUIDE PRE-OPERATIONAL CHECK • Verify annual calibration due date has not expired. • Conduct a physical inspection of meter. • Turn the multiplier switch to the “Off” position. • Turn toggle switches to “AUD ON” and to “FAST RESPONSE.” • Open battery compartment beneath handle and install 2 D-cell batteries. Correct polarities are engraved on inside of lid. (+) should touch the positive side of battery. (-) should touch the negative side of the battery. • Connect cable to unit and a pancake (44-9) probe. Remove protective cover from probe. • Turn Multiplier Switch to lowest scale (X0.1) and press and hold “BAT” button. Needle should deflect to “BAT OK” or “BAT TEST.” • Open the source window and place open probe against source while looking for visual needle deflection and listening for an audible sound. Then remove the probe from the source. This is a “response check.” • Turn toggle switches to “AUD OFF.” • Place open probe against source for visual needle deflection, then scale up with Multiplier Switch until a steady reading is obtained that is not off-scale. This is a “calibration check.” • Each probe shall read within +/- 20% of the reference reading found on the calibration sticker. (see “A” on next page) • Cover probe with plastic wrap, non-freezer plastic bag, or latex/nitrile glove. This prevents the probe from being contaminated. If using bag, secure to probe tightly using rubber band to ensure nothing is hanging down. If using glove, fold back fingers and tape down toward handle. • Turn toggle switches to “AUD ON” and to “SLOW RESPONSE.” Close source windows. Change multiplier switch to X0.1 and press “RESET.” • Take a background radiation reading with probe open window (X0.1 position) using the pancake probe (44-9). Average background using a Ludlum is typically 50 counts per minute (cpm). • Turn toggle switch to “FAST RESPONSE.” • For problems, contact the local EMA.

91 A

92 93 Patient Radiological Survey Sheet

Patient Name: SSN/ID Number: Date:

Instrument ID: Calibration Date: Battery Response Background: Nasal Swabs: Check: Check: (R) (L) Survey Completed By: Signature:

94 Area Radiological Survey Sheet

Area(s): Date:

Instrument ID: Calibration Date: Battery Check: Response Check: Background:

Survey Completed By: Signature:

Perform survey

instrument Door checkout process Be systematic Focus on high-touch areas

Document on Entrance survey sheet Door

Comments:

95 470000 480000 490000 500000 2025000 2050000 2075000 2100000 2125000

d Grigsby Fer O ry R O R d w C C lo ol Coffman Rd CR-117 H H d Huber Rd Upper Snake Rd t Cannon R Cagle Rd o et

E n C l n CR-123 E l in Rd BROWNS FERRY a o

a t

t Goodin Rd S ir p O

n o L d N l

d H m

p d

G o a R T

l o E A r lo H O R ic i t n s o CR-55 Franklin w r lk CR-86 d Lovell h Hays Mill Rd o L o k o m t D a Rd F T o lk Rd m C o CR-92 R Rd o ro E n Black Rd S s R B 10 MILE s id R Harris K t 350 e R d E Tucker

g y Loggins Rd E 0 Myers Rd d Harris Rd R CR-97 e d Rd 10 Barker Kimbrell

D

M CR-555 R

I d Rd U o Rd (NNE) d L A n A o n Smith Rd R

Hickory Hills R Poff Ln d y

L 340 ¬207 R e « 20 Piney Chapel Rd n d d R o CR-559 CR-26 lR o il Elk River Mills Rd E n L CR-119 (N) H d Sewell Rd to g k ry e l o Rd Quarry Rd ck w E (NNW) Hi Easter Ferry Rd o Oak Rd o ¬127 Dugger CR-225 « o Temperance d Turn Rogersville Country Corner Rd o R er d Li CR-125 ndse 330 y Rd Kimzy Carr Rd d 30 C Rogersville R EVACUATION SECTORS Anderson Creek Rd d Recreation r s o Athens W e B F

l Mill Tillman Rd a a Park i d d k t s n CR-566 M Elk Est e R CR-66 r o e Airport Rd Bill Black Rd y (NE) Rose St n s CR-165 H n e Compton Rd 0 Rd Yarbrough

R

CR-567 i r

l

l w

1 o

Lentzville Rd d R o

T C d 99

t

Wheeler Wheeler St «¬ a

Richter Rd L G i

S t Q o eS a Pleasant Point Smith Gover Rd d d t l Rd S CR-570 rsi k a y 72 College ive e n £ L o ¤ R s o s s Lee St 320 id d s 354 R H n R e i o k 40 l i l v E rtis lo Rd Thompson i e sta Cu w (NW) r te R t W f J-10 d r s New Cut Rd o d Rd S n R W Elm St 31 r Cox Rd £ t ¤ D n E Elm St s o e s r f El ho l r t k e S B

f REP REVISION 8 S Dr

f Athens

r m e n D Garrett

n R a o Joe Wheeler a Quinn J t Sportplex e y d e R

cl nr r d W lk

5th Ave N B State Park M CR-610 Tipton Rd e E JULY 2015 CR-606 CR-635 E l k RH i v e r S M rview t a Frazier St a Hine St N N Madison St d Cle A-10 rk R e 251

CR-165 1750000 o s «¬ t g S n o

n t 1750000

LindsayN Ln i Quinn Rd r W Hobbs St W Pryor St t

310 p CR-70 ryor S d

S Y n 50 E P

o n

R

Glaze Rd e S

r

u E W E Hobbs St Blackburn Rd C S y k n l

r a J s r B h

i Linton Rd e

e D n t gt f F I-10 r o S

f l n i e

n St Nick Davis Rd n

s r t

s

CR-608 b r o to n Forrest

C o D n m arla s n n

n

a u Parker Rd La W Washington St L Rd Ezell t d k K-10 e S o St v S iew y S LEGEND

R r H

Wright Rd Wright S

Little Elk Rd t r t e e t

t f

v t

R Holt Springer Rd s S e

n A a

n w m t

r o

72 n r r a Elk River £ e b ¤ B 3850000 3850000 Pepper Rd

v l B e Ave

e w State Park Grace

Seven Mile Post Rd o L Evacuation Sectors

PoplarCreek Rd o o RdHardy d

Eastep Rd

Sod Rd o Dr t Limestone S 300 n

York Ln York

o Gordon Rd S Monroe St Fielding Rd Fielding n 60 Cloverleaf County Park s L r 351 PAR Beyond 10 Miles Sectors Hastings Rd e 72 A f Snak f ¤£ e R Dr U r d e Evans Rd J n CR-605 D L D Bay Village W Sanderfer Rd

S A E Rd Davis Sanderfer Rd W R Zehner Rd Grubbs Rd

Hine St S 65 Interstate R D s Reid Rd ¨¦§ D E A CR-91 ile

L Rd Gilbert N E M Ham Rd C P Beechwood E Bluff 5 Blackburn Rd Rd rakeL C Caneb n State or US Highway Rd (ENE) Dr O Black Dr C Hammons W S O train Rd LI Bell Rd (WNW) ME LA ST Roy Long Rd W Roy Long Rd Major Roads o WR O Rd Carter o

N Shaw Rd EN 290 C E 70 Friend Rd E C Ri Ridg pl edal O ey eS Other Road or Street C Rd t O A-5 Jim Russell Ln Malone Rd Wheeler Lake Moyers Rd Railroad

BattsRd d

R Rd r ry r Ferry Lucas Rd e nsfe Riverside Mccormack Rd n row

r h B M Transmission Line 1725000 D

Rd r e LindsayLn e c t Z 1725000 t c o M o

r

CR-400 m Sommers Rd Sommers i

c Railroad Ave Railroad Poplar Point Rd k s Wales Rd Huntsville Brownsferry Rd County Boundary o 347 ile Ln o 280 M MackRd n 80 CR-419 2 n

Lawngate Rd Ln Vanzille d School Hightower Rd R e CR-150 g a

Paradise Shrs NeelyRd P ¤£31 CR-423 B-5 Urban Area uclear Plant Rd

A-2 N Dogwood Flat Rd CR-592 CR-403 B-10 Recreation Area

Nuclear Plant Rd Stewart Rd 96

H-10 r Settle Rd Settle

D

Sandlin St Water

s

CR-418 e

o N m Rd Cowford E o

Hawkins Dr a CR-443 B-2 Lindsay Rd G-2 J Ingraham R 270 d 90 BethlehemRd Stream CR-420 BROWNS FERRY 3840000 3840000 (W) CR-441 NUCLEAR PLANT (E)

HatchettRidge Rd Goode Rd B r id CR-425 g e H fo a r tch th ie Rd d G-5 Ln H Laughmiller R

CR-389 CR-426 d a Martin Lime Rd r CR-388 R r 72 is y

¤£ a ALT S B t a d t R n Beulah io ete n Pe R d o CR-421 o CR-422 F-2 CR-393 260 Courtland CR-387 100

1700000 T e n n e s s e e R iv e r

St Jefferson 1700000

College Tenne ssee St Snt

O St CR-439

O

C

Monroe

Alabama St

C CR-438

E Thomas Hammons Rd Garrett Rd

N

C

A

N CR-383 F-5 Mall E a F G rd arm CR-436 Fox Dr NW

R Rd R LIME STO

O

S W MOR N o 20 CR-437 G E a o CR-281 «¬ A n

A

M

CR-150 N d

y L C 250 O 110 º C M O W h e e el rL a k e Rd Airport Rd State CR-381 CR-579 Gle E-5 D F

Oakdale Ave o

n c

Blvd vi k

Iverson Main St s

e d CR-285 72 w

Red Hat Rd

(WSW) Dogwood Rd R R

D

¤£ d

ALT M d

r

n (ESE) a

a

CR-433 l Hillsboro e

s r

G-10 I

d o

y R

S 72

e Rd

l t

Beltline n ¤£

n o i ALT

NW i t

F

c u

CR-284 CR-277 r

t SCALE 1:64,000 o s MarketS o

CR-377 n t Linde Ln Linde

o N W 240 CR-429 C Lafayette St 120 72 NW Landfill Dr W 31 1 0 1 2 3 4

W 20 £ ¤£ «¬¤ il ALT s e

o V o v i W n n

o e CR-432 km

A S S d t Kelley Rd N N N t

a W h

t W Wilson St l

l W C-10 3 Ste W Plugs Dr e 1 NE d N Rd R Decatur W CR-376 a r NSeneca Dr d ln N 4th St NW

D u 1 0 1 2 3 R W t l nn e S

A N

a 3rd St NW d n v E i t 3830000 3830000 e

Ipsco St r N A N

e e E CR-288 CR-577 o 2nd St eC M mi D v h v Mcentire Ln h t a m A nu

A r 1 N r k CR-222 W h n Mountain Home Rd e c e CR-222 t Old Trinity Rd 1 h t

B h St S W Moulton St M 6 t Moulton St E t e G N

2 N a or Johnston St SE E E 4,000 0 4,000 8,000 12,000 16,000

tr N 1 d 1675000 1st St o Grant St SE G ic CR-427 n D W SW 1675000 e F-10 r r d ft o e S R S W ShermanSt o B CR-431 Trinity e

CR-372 n 2nd St SW n e n Summer l to Ave v l v SE w d u E-10 A 230 P

a o 130 E r 3 y n a os Monogram s w h e p y e h t 7 ig c S v t e E H nD E

4 t d M E 5 d D l Tower St l E r O A CR-374 S e e S

1 P a

CR-290 O S SE S

r t v n o Dr 4 v Douthit St SW W

h 2 e i

C e n s n

67 t

A S t e A v «¬ v M

k E e 4 E 33 E v

r

A h «¬ A a CR-365 John Johnson Rd n S t h l

e A S a l Tho d mas DrS t t a

h

h 8 CR-284 r g 8th St SW W r r t P t d R 9 a h 8 th St 1

a e H t D il ls 6 D id 4 t e CR-434

1 r l

i

v 7 r

e

1 P 1 r CR-294 S

y e Aquadome

D v E A 8th St SE e SE

W k v a

Fr A em E w H o S A n n w t St S Park h n i W

S CR-291 h n t W

n y t Harrison St SE CR-556 a n h

t n t 6

e S

L 8 11th St SE n SW 9

e E l Pennylane CR-253 y ea r h n no CR-362 u E t 1 r CR-358 D

L a e CR-249 Projection and 10,000-meter grid, r E CR-369 o K G S

SW v CR-217 WoodallRd 13th St SE Old Highway 24 Westmead S M St S North St SE W A e SE E S

e o D-10 v Zone 16: Universal Transverse Mercator S o h College St

v S t A

SSeneca Dr CR-364 Betty S 5 SE A Point t S h 25,000-foot grid ticks based on d t H nW t R s i h t 220 l l 0 l o CR-250 i l 140 Mallard (SW) CR-360 h Rd Magnolia St SE n H 0 G 1 n W CR-287 ost Auburn Dr SW oodlandS

n 2 Gh W t SE Alabama (West) coordinate system CR-296 Carridale St SW W S Park V G CR-298 Mo Stratford Rd SE rg A e 1983 North American Datum CR-299 an nd Rd CR-370 R CR-368 e t

d rso B le e l r n e W i D a Brookmeade Rd SE v C rS l Cedar St S n d t i n R W W l t o

s s n S i e Bunny Ln n SW u u to v l e A (SE)n u Jack Allen D A t o n r R r CR-302 M y g CR-214 n d Recreational d S l n C i E Gordon Terry Pkwy r Adventure Lamon Dr O S l Complex u o p d o 24 W b

CR-301 «¬ S R Park Hu Shady Grove Ln SW Rd CR-386 ds ne R Whitlow on Rd Belt Beltli 210 Modaus Rd SW 150 line Beltline d Rd SW n SE S d Cedar SW Lower River CR-245 R Dr Rd E l l n i Du Rd Ridge Park E H nc y Pointe Mallard Pkwy CR-460 an l

s S CR-246 t by r Dr SW Old River Rd SE n e George Dr CR-251 d Produced by Tennessee Valley Authority b

CR-308 CR-309 a CR-358 CR-307 s Galahad Dr R W Harold Dr

m

a l

i

l CR-352 W W Cedar Lake Rd SW CR-305 le SW i in cooperation with S S

o W Ch

o H K J P CR-243 H d a e y

CR-327 v p R Alabama Emergency Management Agency or

n W 200 e A

e 160

k

CR-244 l S

l l c CR-316 i i

CR-315 lRd g l e v n H 67 H n «¬

e i Ve v s i ll n tavia

s D r Tammy St SW

(SSW) A (S) R a s (SSE) 157 p

«¬ o o d r n l Upper River CR-312 CR-318 u D S a

CR-221 S R W r W l Hill Rd SW t Rd SE

CR-170 o e n BASE REVISION 2015 e S p

190 170 e r g a 31 CR-501

r ¤£ h D C

Raper Rd o C CR-230 a 180 e t CR-236 Vis G la CR-241 u CR-345 h C

1650000 2025000 2050000 16500002075000 2100000 2125000 470000 480000 490000 500000n Chapel Hill ¤£412 270 400000 410000 420000 430000 440000 450000 460000 470000 480000 243490000 500000 510000 520000 530000 «¬ 540000 550000 560000 570000 580000 1775000 1875000 1975000 2075000«¬ 2175000 2275000 ¤£41 2375000 ¤£412 ¤£231 «¬53 k «¬166 ree C 31A ne «¬269 E ¤£ ca O i

B a s rr p u i t H g R o by Creek o s 431 R ig c s reek B B £ k g ¤ u C i use i B o C Wartrace ho g m ock rk Mount c r 24 R S o k e F o 50 e C w § k ¨¦ Hohenwald t ¬ C Shelbyville « r s Pleasant a k e r e BROWNS FERRY ree C n e e es W it e k Wh PERRY C k

r 0

e

e o

DECATUR k 3930000 3930000 «¬69 «¬48 «¬20 o MAURY 41¤£ ALT Manchester LEWIS 10 50 MILE 350 64 D 64 55 B «¬ ¬ «¬ u « 128 k 114 «¬ 13 e e c l Normandy Lake e k «¬ «¬ f r Buffalo River C o a R A s in E i ta t 271 S v Normandy 373 e o n a C ¬ « i ou ¬ n BEDFORD F « r s ScottsCreek S k r t i L n e n 20 R COFFEE i a e t g o t k k l C e 340 e c

k r B C e u r C e e k f (N) r f e k a k e e l k e e o e k r R A e C G n r i d R n B r v e C e o e e e r c s s h e r 43 o w BLewisburg C MARSHALL p INGESTION PATHWAY ZONE (IPZ) n £ n 3920000 3920000 ¤ re o o l

e C m k R

n r o i o e

v e w h e 82 T k o ¬ r « r 30 330 (NNW) B Lynnville (NNE) ALA - TENN RADIOLOGICAL «¬114 «¬240 Saltillo Clifton «¬166 Cornersville EMERGENCY PLAN Eagle Creek 1950000 k Waynesboro e «¬55 e

r 1950000 H C a le F Ethridge rd ag o in E r C t D re y e e r Petersburg o 128 k i y «¬ g 231 Tullahoma W o h 242 129 ¤£ 3910000 3910000 ¬ ¬ t « «

e 431 k C a ¤£

64 k k e

r £ e 40 l e ¤ r e Woods Reservoir

ek e k e C re e e r

Indian C 320 e y an

e C Estill k le r C Litt C C r y k l e 129 r Springs e a e «¬ r o k 64 e e 279 £ r C h ¤ b «¬ S r l C o e g w tl u MOORE o s t Lawrenceburg i M o k H n L e 41 ALT 31 k £ 127 e r ¤ C £ ¤ 31A r «¬ r ¤£ o 130 e C «¬ Q F e s k i r 244 W «¬ r k o G Decherd e White N i re m C Indian Cre le n ek WAYNE House t o C o (NW) re C B e 3900000 3900000 64 k ¤£ k o e Tims o LAWRENCE e k r e

k e B HARDIN C ee r r C u n C n c 50 Ford Lake n a a a 310 w h GILES n S 64 w £ S a a ¤ Pulaski h e n (NE) l c tt a u i n B L 50 C «¬

r e 64 e ¤£ k k Turkey Cree ¤£64 Winchester C REP REVISION 6 h i s LINCOLN 13 h k Collinwood«¬ k o e k e e IndianCreek e l r re Last Butler Creek m e C r C JULY 2015 r FRANKLIN s C C er l ea g r a l o 203 e o C R R e h ic 3890000 3890000 «¬ h 242 S l k a «¬ n Fayetteville 11 d «¬ C 65 121 r ¨¦§ «¬ k e

e e e k H r C o o l o l l West Fork Sugar Creek a H y o h o C Loretto E er l S lk Riv l r 60 a k e k 300 e r n e d e k o r B F C 16 C L u t ¬ r s « i e y t tl 166 1850000 s tl e e «¬ e s e 98 k r ¬2nd Creek W C « a r y C p 1850000 G k r re eek Huntland e e e Cr e ss k er 64 r t 275 ¤£ C Elkton a «¬ C r w e ld s e Minor Kel o s ly C C e k re 3880000 Pickwick3880000 227 ek 69 r Iron City «¬ Hill «¬ p 122 y «¬ Lake C ¤£43 «¬273 D P 227 ¬97 «¬ St. Joseph Ardmore «

S 110 East Fork Shoal Creek «¬ k u ee T E N N E S S E E g 2nd Creek Cr Hurricane Creek a er r t k es (ENE) e C H e r r B (WNW) A L A B A M A e S C e r Lexington h i s k o e s r a o e o l L F r

C p i o t r

r y t C

l k Lester e C e o

e F p k e k 70 L e 290 l l e i e i l d n LEGEND d m a r i t n Hazel 3870000 3870000 64 k C e d «¬ e R M s e e i C B r t v n u M o Green C e r a r n e c l r l u c h e e i Elkmont i a d k

k New r

m C M e r Waterloo d e B

C y r u k r

r e e e C Market H PAR Beyond 10 Miles Sectors e e C

B e r e a k Hytop k r k v l d

e C e u e 79 n

Brush Creek e e r ¬ s 17 f «

2 f s «¬ r k d 157 e C «¬ a L Underwood-r C 231 i p 127 m r k n t ¤£ e

e d y ¬ s « T s re e e C e 1 PetersvilleC C n k y Anderson

t r

C e Elk River n n e r l 99 Evacuation Sectors e t e

e «¬ e ek t r

i m s k s e Piney Creek Meridianville e L v e A i e D Moores R 207 n k «¬ d c R LAUDERDALE e Harvest o r Mill R 20 Killen s t i «¬ o St. Florian 251 n v n «¬ 53 r i k e a Interstate 3860000 3860000 «¬ C e v P e e i r r

e R e C r t k

Florence g n i i 146

l «¬ B o ¤£43 F o Skyline Athens 65 State or US Highway k «¬ 80 280 La 72 e ke ¤£ e on r ls J-10 LIMESTONE C i Rogersville e W n o Hurricane Creek

A-10 t k s County Road. Street, or Rural Route

JACKSON e e

1750000 e

m r I-10 i

K-10 C L S 1750000 i n s k ek s in e e

r u g C C d G 3850000 3850000 Bu n Huntsville zza P r sla Railroad rd Cherokee i e D d I R c e un o k 133Po r Ro o k «¬nd C y s w reek C t 72 r C ¤£ i e MADISON r c 184 e e k «¬ e k e W k A-5 72 k L a ¤£ ak h ee er L State Boundary e 101 B l «¬ i BROWNS FERRY Muscle g N 255 F

a k «¬ l n i Shoals c e nt Gurley Pleasant

e R 97 Sheffield e NUCLEAR PLANT i C r v r 31 er £ C e ¤ Groves reek e k k B-10 n y C ee H-10 A-2 County Boundary r Leighton r a o D C E w o n Town G-2 M+ w S o North

Tuscumbia T Creek G-5 B-5 k

B-2 5 e 270 Courtland e 431 90 10 r £ 3840000 3840000 20 30 ¤ 40 50

C Madison 72 ALT F-2 P City or Town ¤£ e i COLBERT n 20 Paint n «¬ N e (E) y o North Sauty Creek t 35 s Rock C «¬ e r P e m 72 a Scottsboro e i ¤£i n k L 231 Redstone ¤£ t Tishomingo C F-5 R a Courtland o Water ne 20 c (W) «¬ Arsenal k C E-5 r R e i e v k G-10 k e ree r oose C ALABAMA G MISSISSIPPI Hillsboro C-10 Stream Littleville «¬157 Mooresville «¬79 k Owens Rock Cree F-10 Cross C Triana Scottsboro 3830000 3830000 Woodville e Roads d 33 E-10 a «¬ r «¬247 43 C ¤£ Trinity D-10 r e e 67 k o «¬ o ek Cre rson 260 Maste 100 r e v k k i e e R e e Belmont Cedar Creek r r k Grant C c C o

1650000 g d in r Priceville R Lake r fo LAWRENCE t p r n S e Moulton New Hope i 1650000 h a t Flat Creek P u R Langston 3820000 3820000 Decatur Russellville ¤£231 «¬24 «¬24 Somerville Golden Red Bay

ek Cre Guntersville Lake ITAWAMBA al Little Bear Hartselle ho «¬227 FRANKLIN S «¬36 o Creek Lake W Flint Creek MORGAN o Union 3810000 3810000 250B 36 110 e «¬ a Grove DryCreek r C «¬157 re ek Bear Creek º «¬67 Lake Phil «¬243 k £431 e 31 ¤ Campbell e ¤£ r 69 C Arab «¬ Vina r M a Falkville Eva MARSHALL 187 e F «¬ B Guntersville «¬23 Hodges DEKALB ek 172 ¬33 Cre 75 « l «¬ «¬ l i 3800000 3800000 (WSW) M (ESE) ek k B e ain Cree r ount e C ll M a t Bu o r n C i o Bear l r F ee k rk Creek o 240 F 120 Upper Bear E «¬205 C ab in Creek Lake South C 195 k Eightmile Creek r «¬ e e re e 19 Vinemont 69 k 1550000 «¬ C «¬ y k se e Tremont ap e C 79 1550000 r «¬ Albertville Hackleburg C 17 157 l 3790000 3790000 ¬ « l Rock Creek Rock «¬

Baileyton e k w

Sandy Creek k s e West

e o k e e Haleyville e V R k Cre r r Cullman Fairview e ab Addison C Point e e Sl Sardis C s r s t C Boaz y n C M 431 e g £ h ¤ City r k v u n s e e i 241 e r u e d e «¬ l r p r k k C S B e C B e r Holly s ig SCALE 1:325,000 r e e n B 278 C o ¤£ k w o 168 Pond o k r «¬ c B o

129 R Hamilton 230 «¬ Double 130 ek ¤£278 re C d Springs u k k ree 13 k C k e M C e a e k r e n e e g a «¬ r e r e C e e i l C re r Douglasr C Mountainboro r ek C 31 C B a C 3780000 3780000 £ ¤ d e d k l e u e e G 4 0 4 8 12 C n 65 e M k r le L o r t it MARION 74 t o ¨¦§ e C L 278 WINSTON ¬ s k « o Snead Barn Creek v £ t s e ¤ i r g e mi e r R n 75 C h C CULLMAN i ¬ e r « k p v 179 W c o «¬ S C River u er e 8 0 8 16 24 tahatchee Natural D 91 v e tl But «¬ i lu it R (SE) L (SW) Arley r B Bridge io km rr 278 a ¤£ W k Walnut o c o 17 la ¤£231 «¬ Good B Grove 220 Blountsvilleek e 140 Ridgeville 253 Hope r «¬ Hanceville C Lynn s ve a Susan ¤£11 Dodge r Mud Creek G 3770000 3770000 City Moore 278 S ¤£ p ETOWAH Projection and 10,000-meter grid, lu n g e Zone 16: Universal Transverse Mercator C 44 re «¬ ek 100,000-foot grid ticks based on Bl Cleveland Detroit ack «¬195 Altoona o wa o ¬132 M te « Brilliant r Cr Attalla Alabama (West) coordinate system

i ee k l k r BLOUNT l e Gardene C 69 e iv 210 «¬ r 150 1983 North American Datum r R ek e 78 Cre ¤£ C City r e e Lewis Smith Lake o no k Guin r ri Ca e r e k a tl 1450000 c Nectar it k a W L Nauvoo e h k Rosa Oneonta e c

T 1450000 r a H l C 3760000 3760000 L 5 B l Beaverton u 13 «¬ l i x «¬ Colony a S M Steele

p p 278 r o r o

£ a i

Buttahatchee River ¤ n e K

l g J l v i C LAMAR l i re 31 a M ittle N R B e ¤£ e k (SSE) L C w 200 u 160 i R w Carbon c r i l 257 e l k e v «¬ e 17 Beaver Creek e C C ¬ r N Produced by Tennessee Valley Authority « k Hill re r ek 160 e «¬ Gu-Win Eldridge (SSW)e (S) k o o 231 Rainbow 78 Smoke Locust ¤£ ST. in cooperation with ¤£ WALKER o City 190 Bla 69 170 Rise Fork CLAIR59 Rainbownoe C rCityeek Jasperckw «¬ ¨¦§ a £411 Alabama Emergency Management Agency a C ¤ ter 91 79 Allgood Cr «¬ 11 ig k e «¬ ee e ¤£ r k 180 B C Kansas on Hayden «¬129 arr B e Creek r 3750000 3750000 Bogu e FAYETTE Glen iv Highland Sulligent r R Allen rio Lake «¬77 BASE REVISION 2015 ar 78 ck W ¤£ Bla «¬75 «¬107 ¤£43 JEFFERSON Trafford Warrior 1775000 1875000 1975000 124 2075000 2175000 2275000 2375000 400000 410000 420000 430000 440000 450000 460000«¬ 470000 480000 490000 500000 510000 520000 530000 540000 550000 560000 570000 580000 Sipsey County Line

1

r s H 3

D t 4

0 a

K County Road 99 Drivewa 7 F d e ie y l 1 R

C 1 - ounty le o d Mill Plac

y e l R n R s d o o d O C mo

County Road 70 w a r a a d Brickyard Ln o C 26 d S to y ld G u u 2 o n o H )" 6 61 t k t s r y n )" t c R k R i im R

ty o e o R y a 6 a i 15 r i d

t v d 6 County h B s R e

1 n 2 - Ln l d 0 e y r 8 w W 1 y

R ou H

Jones Rd M ty W n a d 9 C u County Hwy-1 County Hwy-96 o i 2 M )" C Sn 12 i hitcha Hwy-47 )" ll rd 27 t ty R P ¤£ n 27 d l ou -1 County Road 1 12 County Road 121 C )" wy 39 Pit Rd

3 C C J County Hwy-165 unty H a «¬ C o C 3 C yden St Stovall Dr ck Wright Rd o a ou H o n r o u d

ty 12 u u n H a

wy n D Ha C " rold

-1 ) t Rega

2 n t o n r y B

y 6

County Hwy-107 o t l R e v

y d 0 u H S R v

y

r County Hwy-252

t 2

d n H t 45 w n a 1

o o L n )" t R T HowellSt w River Rd y «¬ d y va y a u

a - l

e pe o

y l d

5 7

p

o a

R l o D a s 4 d 1 - 7 20 C 2 S - 6 D Maple St F

R u H

y 1 r ow e w ard o a o La H y n r n h d t t i A t n y Union Rd g G n r v t Rd e 431 n u u a o Arlingto ve £ o i ¤ u n A o 62 n C Church St

Henry County 131 County Henry e C W Rd t «¬ s C 55 h R n 15 n iv S S Magnolia St

" i e ) t r

a S

a

t )" e t y

County Hwy-55

m

m a l

C R o o u e B

n d S College Plant St t 97 e t y )" d r H

Hw R F Freeman y-85 53 Odu Rd Liberty St 8 d 4 )" m C ek St )" Co a re y u o 3 ia R a

nty 85 ty C b ve JesseJ d o d m Ln w A

H )" oun o lu h 200 a e R e 1 13 w C u e o n e t

County Hwy-126 v s «¬ o C n h «¬ )" y i o c lt n r n - t o R o y r Bu 8 o D d a

sh w D 49 h r lv h L y C )" o ta n R t t B T a oa n h St Lancelot h d 1 Sout C

70 y u C

l 1 5 o o 0 e C d u r

d R D

s ill i 6 v

n a y M C o

nce e

t o a Airport Dr o 77 h

y C w u County H )" M n R w H y

t d y y -6 a w t 71 y H

R

y un 6 Odom Lane Rd w o - )" n 4 63 r y C " o ) i

9 D

-

t C S iveB 1 86 b F ri

o a lu d

3 u g n o ty Hwy t C es

C - u

S R

3 d d o 0 R t 2 e 134 un R10-1 Prospect Rd t 57 k h Dr «¬ y 85 e s

County Road79County s d

C y r u i ounty Hw - 72

2

H o

L

AL-134 t

8

k o e C w a Ln 2 3

L 6 y 56 M - A9-1 A9-2 d r -

y l 24 1 County Road 30 y Weepin R

Co a unty H )" g w r s wy-24 r e 1 i t W 1 H 16 r a County Hwy-90 6 2 Rd nty Road y ne Sessions u G l 1 il t o lo e S w n C County Road 18 d u o G p

a T r 55 C 134 r

o l «¬ 95 i n County Hwy-87 County

C R «¬ p oun 34 59 gs Loo ty H y d wy-20 t ounty Roa 6 D C C d R n o a gs u u ko Sp r n ta

o 73 e

5 t

y v C i Holly Ln 1 A8-1 - H w R y y - d King Rd l w 4 G-10

Fort Ln

H 9 O y t 58 n 55 Abdally Ln Mays B 39 y e u unt Hwy M )" o - Rd v «¬

o C i 2 RockHill Rd ll

e

2

Q9-1 r C 9 l

0 R9-1 y

- 2 1 2

H

y )" 35 T 1

i w F-10 h

25 l

l

s r d

20 H d E e a e 13 )" ty R ng Ln o n

" l ) N u

l li R

11 38 i s 22 o t o )" C County Hwy-38 )" h C

)" y o t

S un t ty Hw -22 54 33 L c

y n a 363

N n T u k h

u e «¬ P 62 R FolmarDr 2 o l «¬ 2

- C d 1 y Q9-2 B6-1 -4 y a Co H u y w n 36 C10-1 W d

w H ty C H t a 83 H Rock Bluff Rd ou ty y Everet R Q9-3 m w 41 n t 22 y- m 2 " n ) n )" 2 5

u a

o R C W O Webb To Kinsey Rd m d y u l l r ie H-10 d T Y C7-1 79 22 ve L igm r County Road 25 u S a Pit Rd )" to Ln n Isom c R d i l d R 60 e B S 3 e R a Wy t d t m il on l i d R

ri J.D.Love Rd m d w d c d s R a 52 Z Hightower R

Dover Rd Dover e 32 te North St r R «¬ R r e d R

Lynn Jarvis Rd d y r

e R5-1 74 r

Willie Raley Rd Raley Willie

F

o t

PeaMarket Rd A5-1 54 d GilleyMill Rd )" S R B5-1 n e d unty op R o o r Shira Shira Dr C Hwy Randall Wade Rd RandallWade -54 24 L e 53 t Riv CenterChurch Rd 54 d n r

J )" d a

d D10-1 e

.

R z R d W R Damascus Hilton Rd

B z k a 82 i r olumbi C7-2 61

. m L C a ld do O R P 14 ic O C h M e 54 e o R - e Q5-1 uss u

l t

d y d m nt Buie Rd d d w o S R

O H R R n ll y y r County Hwy-48 t i r t

Jesse Rd Jesse F-5 h H R D e Bus D n s by L w oad 6 e R 4

s d o u Rd n y k J y r o e s h t l - n H n o i c u

C w ll 2 t Y o

o 48 u o 4

a

n R C t )" d

h K S 52 s «¬ s u s h w

s o p B3-1 o re Hayborn Rd n 23 e 37 p C S d R Big Pine Rd Cy ndrews Dam Ln I-5 R A 4 51 P8-1 d D8-1 87 -5 31 33 12 B e )" iv y ins w ui d L L r n H B R o

t D w 24 ty r s M e )" n i i S awn e 38 u t ll F z r kory er e D4-1 o ic Ct 13 R I-10 O H n C e P4-1 iv Echols Ln Hu D e Curtis McCorkle Rd b nter Rd 95 r E «¬ a m R 15 d E-10 d R R Old Webb Rd d Do F h 8 w ur c r r y 54 Eddie Smith Rd R2-1 R D5-1 n u )" i d d E9-1

e F Melborne Dr 39 o h

l R Rd Ludlum B2-1 d k E-5 41 s C Bud Justice R Rd )" 52 R p Enon Rd a Flat Creek Rd «¬ d um i G o B 55 n r b )" i o D3-1 g

m 11 d

Hopkins Rd g Huskey Rd i

King Rd Rd Meadows Hollis

e d J s d c 16 l R a L R 80 Goodson Rd e S p u n M h a c i e h 30 k f C i C f n l Sussie St Sussie ie Alle l a d c l e n R P1-1 d n e ra M R o c B i d n n d ll

da e R E7-1

l R A P e d

Cir wr Rd i a se y z L e e

1 z n d N8-1 e 0 l N4-1 p O D M1-1 s r le R Edse l Cedar Springs Rd G D la G 22 o o 7 d

n f m d E3-1 aw R a f a d re yh R r M Ma

g d R

a g R R Warren Rd

R n e r d ie I y i 39

e k n e H Fain St l ¬ n v « i h I n u O o J Waters Rd s n u W J-10 m d Clara St r R e e k it h Rd Williams Roy e u B B 3 W 62 y s s k -3 s

c u

e y f d R Ru 65

e 50 a w 84 r R t i

d

S R J H F6-1 s

d PeachFarm Rd ty d FryerRd

s C n M4-1 l l ou t R m

a CrawfordRd C s a

i e i Mi l

Spooner Quarter Rd l

Wicker Rd Powell Rd Wilke l J.B. Jackson Rd rson R 36 Lisa Cir Ju Baxter Rd d

JordonAv " A E10-1

e ) s Wi

hf d n

o 10 K2-1 363 l rd L

uth Ci B R y «¬ Big Oak Rd 64 r d e o Lamp Brothers Rd Eastgate Dr R lu e R f v

Eudon B R f Ashford J-5 F7-1 z S D o

St a 6 ter prings r 370 R a 33 D-5 «¬ -3 es d Academy )" G Bruner Pond Rd 9 H y J y t n Jo Evans Ln w n

H R L4-1 Watford L a g

B y d t Evie Ln s d n 29 Bruner Mill Rd p r 77

a

u R 63 o S d l o e C 84 a s l G4-1

£ R a ¤ d Funshine w ie Jacks Dr Vann P Holt Ct rn on u h

9 F Rd o p t l S l

1 17 e e m - e Day Care F6-2 t F v a B

y C Helen St S Old Highway 84 21 L F10-1 BrunerRd d A 52

w h 273 RK a l n e e

r M d a H in L «¬ Revells Rd t v l g r v S u 6 d

a i t e

e D e s s a

y e A A r

t i

Pre R R

vat f v 1 t R t

u 40

d B d n r a t Strong Rd P ie m d t h K-5 Parr Ln u A r ll t s Powe

o a Rd Randy 3 a 6 75 Dead End Rd

y K4-1 C s )" 2 P County Road 83 273 Junky a a

er 10thAve rd Ln

at Ed Tolar Rd Neal Rd R f

o «¬ C O

W S w

12th Ave 12th WidnerRd

r ak Taylor Ln

d d d l S

t r h

a i

a W M8-1 J4-1 y G e

C d

o rim C-5 G5-1

t r S d a

d s Dr y y

attles R o l e l R 20 GA-273 B y a B n l e

R P d n r H4-1 R 84 an C 42 i k se a Millard Ln l t £ ¤ y D

d e l o a R R d i 19 7 r e r 7 i r o D u v y Bell Ln 2 c n d e C

a w ty n

D k Ro

v

L L6-1 a s y a t C

D e y an s d d i Phila l r f l

y p r C o C

erty Rd e ms y a h Lib s a

r R i li d HarrisButler Rd l L h r i n

i

a 48 n e a Side Camp Rd w o R t W t R

EarlyCo LineRd

y a o i e R c d n

C Etheridge Rd Etheridge F9-1

b en Frog Rd D d d re e A k a G d r C s R F e r d t

R o e

d D r s g a 49 d C McDanie r RdCook

l F e m D-10 d Rd iew V R u ev s rRd in Avon Rd n b G6-1 Ki e e P

R r d 28 G7-1 l n l a p

d r i ar

K

a L B-5 J6-1 n H e L9-1 y R

Aspen Rd 81 Meadows Rd y 26 78 d

d Enterprise Church Rd K-10 m Glass Rd

MoultonRd R K-10 Carver

t x m Amber C Buster Rd i H6-3 o J School c Harvey Hicks R K6-1 20 il d J6-2 B )" S Cou Leslie St 18 uc Coot Fow 2 nty Hwy-2 4 H6-2 k ler )" h

Rd C d Hunter Rd 41 a d K7-1 o n Rd R l d u Curtis Mixo t

e n R 39 R mps Frith Rd l t De ey Rd «¬ r y A Paulk Rd H6-1 l t

a H t B R

b H w e d r odi r

a Tifton y r Rd Church Creek

3 - a m 2 Dulaney 81 84 3 f 0 G O Thomas Rd

MasonicRd - o )" ¤£ J7-1 r F y d F L9-2 l o Willie Smith Rd Smith Willie d H7-2 67 w o R US nel Walter Rd Hi rd H d y S l R w g Bill d 47 hw L l ay e d y 84 n t Shingler Rd r R 370 ith n h Rd Parrish Rd «¬ R u Antioch Churc d m o 27 L8-1 K8-1 43 O Jakin Rd Pritchett Rd S C Wh ld J r itaker R U eff B d a d S il Brown Ln r R Nix Rd D d g H lin Whitake d usty n i g L R 75 Turnpike Rd gh s E )" J7-2 w L 53 s K8-2 68 ay n H8-2 «¬ m 8 4 da C A B A Davis Cherry Rd W Halstead Store Rd ot o d d som Ln o a P ill J a 55 w ms Rd a i a R E G " C 45 ul am Fuller Ln ki n u ) e d J8-1 Jeffco s s n iggins R C-10 at Rd R

L W Rd Firetower d o K R v H8-1 e d M i 46 66 t a R t c

s d a 101 A rt )" l R B d h 38 b Swee ec k R e «¬ e tie r rt Smith Rd d 8 Bobby Hall Rd R R

B iv Sapp Bridges Rd Bridges Rd )" d d ers D

u BridgesRd R

2 Stegall Rd 1 r 33 d )" B-10 8 b 44 7 )" 75 - 8 M 2 m y 69 ad a o o w R o L y r H t e n k y Dot Harvey Rd hoolhouse St u R c t 85 c " o d n ) S o u C Nobles Rd D o Elm St lvd Pearl St E C County Hwy-8 t B

S a Z d 8

a i Jeffc o w d )" c i Leo Pynes Rd O n H l h S d d B a R e u Rd a Pool Rd

g i

p 88 R n r e ld b

M h y es t F ri l Rd y e e dg

l e i y i e R s e n m s s F R e o d e z b d d r h 81 v l R

n d e

d Rd R r )" r Drivewa s

P d o d a R R y k G 76 d

y H

R D R y c r

e

n

a o d y d e Q

R Pilcher Hart Rd r ster GodwinRd Roo R n C r Burl Lee Rd Billy Cherry o J King-Santi Rd e G h m Kirklan d s N

c d a e o R s Rd H e

T ouse Rd 89 R d w Leon Barber Rd M Phillips Rd d d

R b

W e us H e n b ol

MurboR y to r e O P n Rd r d l d y d R G J

County H i a w C y-2 JoeR t k SmithR Charles Rd a n Ansley

r h

Billy Ln y d i he d d a D n

c R u

t M H S r R e R m F l e d unkoR l r B d

Todd St a Jerusa

a g c

d

c n

R r i

h s N d K County Hwy-55 95 r

a e e r e R l R il «¬ l y l

R a l

M d d D o M f 2 Jun d d d e )" e R f s d a t o c k King Rd 1 R S Roscoe Dupriest Rd y Hou a Cottonwood r 0 e s lf h a

t 1

B c R o S - r n High School y

S t u d t Hickory Grove Rd w h R H C i Housto v

n y Roberts Yank Rd Grove St d S t m e ri D HodgeR t R n r W g d G u il R County Road 65 r h d a a o P d nge R

onyHwy- County Saint Jo Rd y C hns r nc Wood St n H y a d u S e g e r h l t C R 8 s Hickory t B d S R l " a ) R l m d l r i y i 101 r k k Melton Rd

Sellers Rd Buntin Rd )" LeroyJohnson Rd u s M G Macon Dr o arton Rd p e B o y G rk h p r R d t D s Rd R GA-285

C a 75 d G h d y 55 C a o us ug b C

y r )" H h 285 )" g R g e g W C m ou «¬ 4 o o e t ill

a z W d B n 3 J d a

53 d

l B

R

d «¬ e R R

d o n s m Miller Merritt Rd n Crosby Rd R t

io M a

Landing Rd r m Z g s a StMatthews St John Church Rd Ramer l i l t e p el County Road 34 n n

e a r

e H

u

d e

W r o ow Pat Wells J D

y R e BrackinRd

ReubenBrookins Rd l M s d ir

R

a F Hwy-4

sca e Rd Waddell y d Co unt

S O 4 Ramer Loop Ramer )"

Version 3.4 G Farley Nuclear Plant 500 kV Primary Limited Dec 2019 Access or Interstate $1 Field Monitoring Stream/River Highways Points Joseph M. Farley Nuclear Plant Water Body Primary US and State ! Sirens Highways Swamp/Marsh æ Churches Secondary State and Emergency Planning Zone County Highways µ ï Cemeteries k Minor Roads Miles Schools 0 1 2 4 10 Mile Radius Local Street

98 STHY 39 STHY 27

STHY 41 STHY 41 Americus Kite Rd Americus Macon 431 STHYSTHY 26 26 SpurSpur STHYSTHY 153 153 280 Richland STHYSTHY 165 165 Richland Russell Preston Plains Plains STHY 195

STHY 195 STHYSTHY 110110 280 STHY 49 Jimmy Carter NHS STHY 49 STHY 308

CORD 37

CORD 37 STHYSTHY 2727 STHY 41 STHY 39 Conn STHY 41 A STHY 39 Conn Lumpkin Sumter Union Springs Webster Leslie De Soto N Stewart B STHYSTHY 377377 82 Bullock Weston STHY 520 STHYSTHY 39 39 NNE 19 STHYSTHY 5151 10 0 Smithville 20 R 350 Parrott

NNW 82 30

King Rd King Rd Bronwood Montgomery 340 Eufaula STHYSTHY 195 195 STHY 239

Philema Rd S Philema Rd S Georgetown STHY 45 C Quitman 40 STHYSTHY 118118 Lee

DaleDale Rd Rd

STHY 30 NE STHYSTHY 3232 Clayton Terrell 330 Barbour Leesburg STHYSTHY 3232 Dawson Worth

STHY 55 STHY 55

STHY 39 STHY 39 Shellman CuthbertRandolph Sasser STHY 41 STHY 41

50 STHYSTHY 91 91 CORD 105 STHYSTHY 223 223

29 STHYSTHY 133133 Banks 320 Q STHY 45 STHY 130 STHY 45 STHY 130 NDoublegate Dr Trojan Way NDoublegate Dr Gibbs St Gibbs St Louisville CORD 1 N Maple St Hwy 130 N Maple St

27 N Westover Blvd 19 Business Pike NW N Westover Blvd Dawson Rd AlAl HwyHwy 130130 11th11th AveAve Troy STHYSTHY 300300 STHYSTHY 95 95 Coleman Clark Ave STHY 93 Clark Ave STHY 93 60 STHY 87 STHY 87 STHYSTHY 234234 Albany 19 Business

STHYSTHY 266 266 Radium Springs Rd Radium Springs Rd

Clio S MockRd Clio STHYSTHY 131131 S MockRd Brundidge 310 Clay D HollyHolly DrDr Fort Gaines SchoolSchool BusBus RdRd Blue Springs STHYSTHY 3737 DoughertyENE STHY 39 Edison Morgan CORDCORD 66 STHYSTHY 6262 STHY 10 Putney STHYSTHY 51 51 Calhoun 70

STHY 216 STHY 216

Dixie Hwy Leary Dixie Hwy Abbeville Bluffton Ariton 300 STHYSTHY 123123 Henry STHYSTHY 45 45 STHY 93 STHYSTHY 6262 STHY 93

OldOld Ga Ga P Arlington Baconton STHY 27 STHY 27 80 STHY 173 STHY 62 WNW STHY 173 STHY 62

Kolomoki Park Rd STHYSTHY 105 105 Kolomoki Park Rd Bainbridge Hwy

Old 231 Old 231 STHY 45 STHYSTHY 125125 431 STHY 45 19 Haleburg Haleburg Blakely Newville Early Baker Old 91 290 Ozark Dale STHY 95 STHYSTHY 51 51 STHYSTHY 2727

STHYSTHY 167167 STHY 200 STHY 200 STHY 37 Damascus STHYSTHY 9191 Camilla Headland Elba Coffee 62 Elba STHY249 STHY249 CORDCORD 123 123 E

Old Stedman Rd Old Stedman Rd 90 STHYSTHY 122122 Mitchell

Columbia Old Pelham Rd Columbia Old Pelham Rd New Brockton Newton STHYSTHY 134134

STHY 87

STHY 87 Midland City STHYSTHY 370370 Fort Rucker Midland CityNapier Field E Pinckard STHYSTHY 9797 Kinsey STHY 45 Kinsey STHY 45 Denton Rd STHYSTHY 134134 Denton Rd Grimes LineviewLineview Ln Ln 52 280 Enterprise STHYSTHY 248248 Headland Ave Headland Ave Boll Weevil Cir Boll Weevil Cir

John OdomD Rd Daleville John OdomD Rd STHY 93 Level Plains Webb STHY 93 USHY 84 Bus Pelham USHY 84 Bus Deerpath Rd Pelham STHY 253 Deerpath Rd STHY 253 STHY 65 STHY 12 0 Colquitt Colquitt STHY 3 STHY 85 STHY 85 Whigham Rd Whigham Rd STHY 112 STHYSTHY 134134 STHY 112 WestgateWestgate PkyPky

STHYSTHY 9595 Honeysuckle Rd Honeysuckle Rd Dothan CORD 59 Dothan CORD 59 EE BurdeshawBurdeshaw StSt Miller STHY 273 12 STHY 273

3rd Ave 3rd Ave Cowarts 210 100 CORDCORD 4040 Ashford BoykinBoykin RdRd Clayhatchee Ashford BabcockBabcock RdRd 231 Bus Avon STHYSTHY 262262

STHY 27

STHY 363 STHYSTHY 5252 Gordon STHY 363

STHY 93 Houston STHY 93 N STHYSTHY 9191 Old 179 N Taylor Old

Old 179 270 Old 179 HarrellHarrell RdRd CORDCORD 1919 Jakin STHYSTHY 123 123 STHYSTHY 111 111 STHYSTHY 97 97 STHY 103 W STHY 103

STHY 45 Malvern Rehobeth STHY 53 STHY 45 Coffee Springs Rehobeth 84

CORDCORD 1919 Old 179 N Donalsonville Old 179 N Slocomb STHY 285 STHY 95 STHY 285 Mars Hill Church Rd STHY 95 Mars Hill Church Rd Hartford STHYSTHY 5252 IronIron CityCity 110 STHY 167 Cottonwood OldOld 179179 231

STHY85 STHY85 Brinson Brinson STHY 188 Geneva STHY 188 Samson STHYSTHY 309309 CORD 220 CORD 220 STHYSTHY 311 311

STHY 109 STHY 109 Madrid Old 179 N Cairo F

STHY 87 STHYSTHY 153153 STHY 87 CORD 271 STHYSTHY 9191 260 STHY 52 OldOld US US RdRd STHYSTHY 22 STHY 52 PondPond ChurchChurch RdRd STHYSTHY 312312 Whigham Grady Bainbridge

STHY 310 STHY 310 ESE CORD 165 Geneva Eunola CORD 165 Seminole Malone Climax CORD 171 Climax CORD 171

CORD 89 Black CORD 89 Black STHY 93 CORDCORD 173173 Decatur Esto Noma STHYSTHY 7777 Bascom

STHY 374 Graceville Campbellton STHY 374

STHY 39 STHY 39 STHY 179 STHY 179 CORDCORD 165a165a 120 STHYSTHY 253253 CloverdaleCloverdale RdRd

CORDCORD 2a2a CORD 164 STHY 97 CORD 164 STHY 83STHY STHYSTHY 185185 STHY 97

STHY 83STHY

STHY 167 CORD 181 W STHY 193 STHY 167 CORD 181 W STHY 193 CORD 162 Greenwood

STHY77 STHY77 STHY 169 Jacob City HwyHwy 162162 STHY 309 STHY71 250 STHY71 CORDCORD 277 277 STHYSTHY 262262

STHYSTHY 179 179 CORDCORD 177a 177a CORDCORD 162162 STHYSTHY 273 273 STHY 177 Attapulgus M CORDCORD 185185

River Rd STHY 302 River Rd STHY 302 WSW CORD 181 Holmes STHY 73 CORDCORD 164164 130 CORDCORD 164164 CORD 164 Jackson

STHY 69 STHY 69 CORDCORD 173 173 Cottondale CORD 164a

CORD 271 CORD 271 STHYSTHY 241CORD241 159 CORD 183b 90 Marianna STHYSTHY 267267

CORD 195 CORD 195 CORD 181 E CORD 277 STHYSTHY 1212 240 CORD 277 CORDCORD 166166 CORD 1084 CORD 1084 Chipley 10 STHY 280a Bonifay Grand Ridge Sneads Chattahoochee STHYSTHY 6565

STHY 83 STHY 83 CORD 269a BrickyardBrickyard RdRd CORD 183a STHY 81 CORD 269 STHY 81 CORD 269 CORD379 STHYSTHY 276276 CORD 275 CORD379 Caryville CORD 275 G CORD 69a CORD 69a Westville CORD 280 CORD 280 Bannerman Rd CORD 273 Bannerman Rd CORD 273

STHY 71 STHY 71 CORD 264a CORD 264a 140 STHYSTHY 1212

VeldaDairy Rd SE VeldaDairy Rd STHY 79 CORD 279 STHY 79 Alford CORD 279 CORDCORD 280280 Alford HardawayHardaway HwyHwy CORD 183 N CORD 276a CORD 183 N CORD 276a Gretna CORD 10a CORD 276 CORD 276 C CORDCORD 276276 W King St CORD 270 CORD 264 STHYSTHY 286 286 CORDCORD 276a276a CORD 264 CORD 270a Ponce de Leon CORDCORD 278278 Quincy Edison Ave 331 230 Edison Ave CORDCORD 278278 Gadsden CORDCORD 270270 PilgrimPilgrim RestRest ChurchChurch RdRd

CORDCORD 268268

De Funiak Springs CORDCORD 278278 Maclay Rd STHY 275 STHY 275 Greensboro CORDCORD 278278 CORD 69a CORDCORD 278278 CORD 69a CORDCORD 270270

STHY 73 STHY 73 CORDCORD 159 159

Lakepoint Rd Lakepoint STHYSTHY 280280 Rd Lakepoint Nortek Blvd

STHY 155 NortekNortek BlvdBlvd 150 STHY 155 STHYSTHY 277277 CORD 170 Wausau CORD 0361 STHY 263 CORD 0361 STHY 263 Altha Midway HastyHasty PondPond RdRd CORDCORD 151151 CORDCORD 347347 220 W Tharpe St STHY 278 STHY 278 Blairstone Rd L STHY 73b Blairstone Rd CORDCORD 183183 SS Washington STHY 73b

Bates Rd Vernon Bates Rd CORDCORD 280280 EE Vernon STHYSTHY 61 61 CORD 194 Tallahassee CORD 279 CORD 194 CORD 69a CORD 279 CORD 69a CORDCORD 167167

CORD 284a CORD 284a SW Leon STHYSTHY 366366 160 STHYSTHY 265265 STHYSTHY 274274 STHY 71

CORDCORD 284284 STHYSTHY 1212 H STHYSTHY 371371 STHY 267 CORD 271 STHY 267 Paul Russell Rd 210 CORD 271 Paul RussellSTHY 259 Rd 331 Walton TALLAHASSEE REGIONAL

STHY 363 STHYSTHY 77 77 170 SSE STHYSTHY 287287 200 Blountstown Bristol 20 Freeport 190 Calhoun 180

STHY 275 STHY 275 STHYSTHY 71 71 Liberty STHY 267 STHYSTHY 373 373 Woodville STHYSTHY 260260 CORD 67 20 CORDCORD 357357 STHY 61 STHY 61 20 K Apalachicola NF STHYSTHY 373a373a

STHY 65 Ebro J CORDCORD 6767 STHY 65 SSW Scotts Ferry Xing S STHY 394 Bay SpringSpring CreekCreek HwyHwy CORD 375 Wakulla

STHY 71

STHY 71

River Rd STHY 12 River Rd STHY 12 319

STHY 388 CORDCORD 6161 STHY 388 HwyHwy 2301 2301 STHYSTHY 73 73

Legend 5 2.5 0 5 10 15 20 25 Miles Farley Nuclear Plant Roads Airport Area Limited Access Higwhay Runway US Highway Joseph M. Farley Nuclear Plant State Highway Parks Railroads Ingestion Planning Zone Lakes Streams Swamp or Marsh 50 Mile IPZ Grid 50 Mile Radius City Limits Version 0.0

99 RADIOLOGICAL SAFETY BRIEFING - HOSPITAL

All Emergency Workers will be issued the following equipment:

o Radiation Exposure Record o Thermoluminescent Dosimeter (TLD card) o Fill out Radiation Exposure Record information Low Range Pocket Dosimeter (0-200mR) o -OR- o Fill out Radiation Exposure Record information. o Black o High Range Pocket Dosimeter (0-20R) Digital Alarming Dosimeters o Fill out Radiation Exposure Record information. (DADs) provided by the utility o Yellow o Maximum Radiation Dosage Limit Card (green card) o Potassium Iodide (KI) will be issued by ADPH KI Nurse. DO NOT TAKE UNTIL TOLD TO DO SO BY EMA. . When reading your pocket dosimeter, point toward a good light source. Read through the clip end. Keep the scale in the horizontal position to assure an accurate reading. . Read your dosimeters every 30 minutes, and record on your radiation exposure record. . The TLD card is your permanent record and cannot be read in the field. . Your dosimeters (pocket or electronic) should be worn on the outside of your clothing, close to your neck/chest area. . Your TLD can be worn under your clothing, but also in your neck/chest area. . If your reach the limit on your black low range dosimeter (200mR), use your yellow high range dosimeter. . Authorization to exceed emergency worker exposure guidelines must be obtained from the State Health Officer prior to any exposure limit being exceeded. This will be done through the EMA office. . Remember to stay in contact with your department’s safety officer. . If you have any questions, contact the EMA office for assistance.

HOSPITAL PERSONNEL:

• All hospital medical personnel will wear Disposable Coveralls, Disposable Booties (slip resistant), Disposable “Orange” Nitrile Gloves, Disposable Latex Gloves, Yellow Plastic Waterproof Shoe Covers, Disposable Head Cover, and Protective Mask w/Splash Visor Eye Shield. . Follow all donning and doffing directions when putting PPE on and taking PPE off. . Do not eat, drink, chew gum, smoke, dip, apply make-up, or put on chapstick while on duty as an emergencySAMPLE worker.

100 RADIOLOGICAL EMERGENCY ASSISTANCE CONTACTS USE FOR INCIDENTS INVOLVING RADIOACTIVE MATERIAL

24-hour State EOC Communication Center (205) 280-2310 (800) 843-0699

If contact is not established, please call: Alabama Radiation Control Duty Officer (334) 324-0076

For additional contacts, please call the following: Radiation Control Office (334) 290-6244

NAME CELL David Turberville (334) 314-6323 Myron Riley (334) 224-4035 Nick Swindall (334) 322-8397 Kevin Hicks (334) 314-6326 Cason Coan (334) 320-3457 Undria McCallum (334) 296-2105

*Current as of July 1, 2021 Alabama Department of Public Health Office of Radiation Control *Destroy all Prattville, AL Earlier Editions 21 ADPH-RAD-1/REV.10-21